ACA Code of Ethics, section by section

Which court case established that mental health professionals have a duty to protect an identifiable person threatened by a client?

1. Jaffee v. Redmond
   Jaffee v. Redmond (1996) is the other famous case and points the opposite way: it created a psychotherapist-client privilege in federal courts, protecting what clients say rather than creating a duty to disclose it.
2. Tarasoff v. Regents
   Tarasoff v. Regents (California, 1974; reheard 1976) held that a therapist whose client seriously threatens an identifiable person must take reasonable steps to protect that person; each state now sets its own version, mandatory in some and only permissive in others.
3. O'Connor v. Donaldson
   O'Connor v. Donaldson (1975) is a civil commitment case: a state cannot confine a nondangerous person who can live safely outside an institution. It concerns the client's liberty, not protection of a third party.

Under the 2024 update to 42 CFR Part 2, how may a client in a federally assisted substance use disorder program authorize sharing of her records for treatment, payment, and health care operations?

1. With a separate written consent for each disclosure
   A consent for each disclosure is the older reading of Part 2 that the 2024 rule replaced for treatment, payment and operations; the trap is applying the pre-2024 rule.
2. Only through a court order in each case
   A court order is the Part 2 route when there is no consent, mainly for legal proceedings; it is not how a client authorizes routine treatment and billing disclosures.
3. Without consent, exactly as HIPAA allows
   HIPAA lets most providers disclose for treatment, payment and operations without authorization, but Part 2 records still need the client's consent; the 2024 rule aligned the two rules only partly.
4. With one consent covering all future TPO uses
   The 2024 Part 2 final rule (compliance date February 16, 2026) lets a client sign a single consent for all future uses and disclosures for treatment, payment and health care operations. Consent is still required; it no longer has to be repeated for each disclosure.

What is the main purpose of a counselor's professional will?

1. To state how the counselor's practice will be sold
   Selling the practice is a business matter for an ordinary will or contract; the professional will exists for client care and record custody, which this choice leaves out.
2. To name the counselor's heirs to her practice income
   Naming heirs to income is the job of a personal will; the professional will protects clients, not the counselor's estate.
3. To list the fees her estate may collect from clients
   Collecting outstanding fees is an estate task; a document built around fees misses the purpose of continuity of care and confidential records.
4. To plan for clients and records after her death
   A professional will names who will contact clients, arrange referrals and take custody of records if the counselor dies or becomes incapacitated, which ACA C.2.h requires counselors to plan for.

A counselor offers text-based counseling. How should she confirm that she is communicating with her actual client?

1. Confirm the client's name once at intake only
   A one-time name check at intake misses the 'throughout' part of H.3; someone else can pick up the client's phone in any later session.
2. Assume whoever uses the account is the client
   Treating account access as identity ignores shared and stolen devices, which is the risk client verification exists to manage.
3. Check identity only when a message seems unusual
   Checking identity only when something feels off relies on the counselor noticing an impostor; H.3 expects routine verification, not verification on suspicion.
4. Agree on code words and check them throughout
   ACA H.3 asks counselors to verify a client's identity at the start and throughout distance counseling, for example with agreed code words or other nondescript identifiers.

A counselor learns that a client is facing an eviction she believes is unlawful and wants to contact the landlord to advocate for the client. What should she do FIRST?

1. Advocate only through the client's attorney
   Working only through an attorney is a role the counselor invents; the code allows the counselor to advocate directly, and the condition it sets is consent, not legal counsel.
2. Leave the matter to a social worker instead
   Handing the matter to a social worker treats advocacy as outside counseling, yet ACA A.7.a explicitly lets counselors advocate to remove barriers to a client's well-being.
3. Call the landlord at once to stop the eviction
   Calling right away puts urgency ahead of confidentiality: the call itself discloses the counseling relationship without permission.
4. Obtain the client's consent to advocate
   ACA A.7.b requires client consent before advocating for an identifiable client, because contacting the landlord reveals that the person is in counseling.

A client has stopped paying the agreed fees for several months despite discussions about it. According to the ACA Code of Ethics, what may the counselor do?

1. End counseling immediately without notice
   Ending without notice turns a permitted termination into abandonment; nonpayment allows ending services, not skipping the notice and referral steps.
2. End counseling after notice and referrals
   ACA A.11.c lets counselors end counseling when clients do not pay fees as agreed, provided they give pretermination counseling and recommend other providers when needed.
3. Keep seeing her without pay indefinitely
   Continuing indefinitely mistakes the duty not to abandon for a duty never to end; the code expressly allows termination for unpaid fees.
4. Withhold her records until the bill is paid
   Records are not leverage for debt collection; holding them hostage would penalize the client's care and access, and A.10.d covers collection separately.

A client's insurer requests the counselor's psychotherapy notes before it will authorize more sessions. Under HIPAA, how should the counselor respond?

1. Send the notes the insurer requested
   Sending psychotherapy notes because the payer asked ignores their special HIPAA status; release requires the client's specific authorization and cannot be a condition of payment.
2. Send the entire clinical record instead
   Sending the whole record overshoots the other way: it violates the minimum-necessary standard for payment disclosures.
3. Refuse to provide the insurer with any information
   Refusing everything confuses protection of psychotherapy notes with protection of the whole record; payment-related clinical information can be shared.
4. Provide needed clinical data but not the notes
   Under HIPAA (45 CFR 164.508(b)(4)) a health plan may not make payment or eligibility depend on an authorization for psychotherapy notes, so the counselor offers the clinical information the review needs from the regular record.

A counselor's agency director tells her to write progress notes that overstate clients' improvement so a grant will be renewed. What should she do?

1. Resign at once without raising the issue
   Resigning at once without raising the issue avoids the falsification but skips the obligation to alert the employer and try to correct the practice.
2. Comply but keep an accurate private copy
   A secret accurate copy does not undo the false official record; she would still be submitting fraudulent documentation.
3. Comply and let the director answer for it
   Complying and letting the director answer for it assumes orders shift responsibility; the counselor who writes the note is accountable for its accuracy.
4. Refuse to falsify notes and voice concern
   Counselors report honestly to third parties (ACA C.6.b) and alert employers to inappropriate practices (D.1.h), so she declines to falsify and raises the problem within the agency.

What is the primary purpose of a professional disclosure statement?

1. To justify higher fees for specialized services
   Fees may appear in the statement, but justifying higher fees is marketing, not the statement's purpose of informing the client's choice.
2. To inform clients of the counselor's credentials and approach
   A professional disclosure statement tells prospective clients about the counselor's training, credentials, approach, fees and limits of confidentiality so they can give informed consent; many states require one.
3. To shield the counselor from any legal liability for outcomes
   A disclosure statement is an informed-consent tool, not a liability waiver; no document shields a counselor from liability for negligent care.

Under HIPAA, how much protected health information should a counselor disclose when billing a client's insurer?

1. Only the client's name and session dates
   Name and dates alone are too little: a claim needs diagnosis and service codes, so this choice confuses minimum necessary with the least possible.
2. The complete clinical record
   The complete record far exceeds what billing needs; the minimum-necessary rule exists to stop exactly this over-disclosure.
3. The minimum necessary for the purpose
   HIPAA's minimum-necessary standard applies to payment disclosures: the counselor sends only what the insurer needs to process the claim, such as dates, codes and diagnosis.

Which ethical principle, added to Kitchener's original five and listed in the ACA Code, refers to dealing truthfully with clients?

1. Veracity
   Kitchener's 1984 model had five principles (autonomy, beneficence, nonmaleficence, justice, fidelity); veracity, dealing truthfully with clients, was added later and appears among the six in the ACA Code preamble.
2. Beneficence
   Beneficence means doing good for the client and society; it is also one of the original five, not the added principle about honesty.
3. Fidelity
   Fidelity means keeping promises and honoring commitments; it is one of Kitchener's original five, and the trap is the closeness of 'faithful' and 'truthful'.

A current client sends her counselor a friend request on the counselor's personal social media account. According to the ACA Code of Ethics, what should the counselor do?

1. Block the client without any further discussion
   Blocking without a word avoids the relationship but can feel like rejection to the client; the ethical gap is skipping the conversation about boundaries.
2. Accept, as long as no counseling occurs online
   Accepting creates a personal virtual relationship even if no counseling happens there; the prohibition covers the relationship itself, not just online counseling.
3. Decline and talk about online boundaries
   Personal virtual relationships with current clients are prohibited (ACA A.5.e), and social media policy belongs in informed consent (H.6.b), so the counselor declines and talks it through.

A counselor's agency adopts a policy limiting all clients to three sessions regardless of need, and clients are being harmed. According to the ACA Code of Ethics, what should the counselor do first?

1. Report the agency to the licensing board right away
   Going straight to the board skips the internal step D.1.h expects first; outside reporting fits when internal efforts fail or serious harm demands it.
2. Follow the policy as a condition of employment
   Employment does not override the duty to clients; a harmful policy has to be raised, not silently applied.
3. Alert the employer and work for change internally
   ACA D.1.h asks counselors to alert employers to inappropriate policies and to seek change through constructive action within the organization before going outside it.

A counselor walks a grieving client to her car with an umbrella during a rainstorm, a harmless departure from usual practice. Which term best describes this?

1. Boundary violation
   A boundary violation is a departure that harms or exploits the client; the trap is treating every step outside routine as a violation.
2. Boundary crossing
   A boundary crossing is a departure from usual practice that is harmless or helpful to the client, like walking a grieving client to her car under an umbrella.
3. Transference reaction
   Transference is the client redirecting feelings from earlier relationships onto the counselor; it describes the client's inner process, not the counselor's act.

A counselor decides not to use an untested confrontational technique because it could retraumatize a client. Which ethical principle most directly guides this decision?

1. Beneficence
   Beneficence is about actively doing good; the decision here is driven by avoiding harm, which is the closely related but separate principle.
2. Nonmaleficence
   Nonmaleficence means avoiding actions that risk harm; declining an untested technique because it could retraumatize the client is a direct application.
3. Self-determination
   Self-determination is the client's right to make her own choices (autonomy); the counselor's decision here is not about the client's choice.

A counselor urges a client from a close-knit immigrant family to move out and pursue her own career, although the client wants to honor family obligations. Which ACA (2014) standard is MOST at issue?

1. E.5.b, Cultural Sensitivity
   E.5.b is about culture in diagnosis, how culture shapes the way problems are defined; the cultural setting here is a lure, because no diagnosis is involved.
2. A.4.b, Personal Values
   A.4.b asks counselors not to impose their own values, attitudes and beliefs on clients; pushing an individualistic choice over the client's commitment to family is that error.
3. A.11.b, Values Within Termination and Referral
   A.11.b bars referring clients away because of the counselor's values; the counselor here is not referring anyone, so the referral standard does not fit.

A competent client asks to see her counseling records. According to the ACA Code of Ethics, when may the counselor limit her access?

1. When the client has not yet finished treatment
   Access does not wait for the end of treatment; ongoing counseling is not a reason to refuse a competent client her records.
2. Whenever the notes hold clinical impressions
   Clinical impressions in the record are not grounds to deny access under the ACA Code; HIPAA separately exempts psychotherapy notes, which is the source of this mix-up.
3. When there is compelling evidence of harm to the client
   ACA B.6.e gives competent clients reasonable access to their records and allows limiting access only when there is compelling evidence that it would harm the client.

A counselor with no training in the Strong Interest Inventory is asked to administer and interpret it. According to the ACA Code (E.2.a), what should the counselor do?

1. Rely on the publisher's automated report instead
   Relying on the automated report does not get around E.2.a, which requires training in the construct and the specific instrument before using technology-assisted interpretation.
2. Administer it and consult the manual as questions arise
   Reading the manual on the fly is not competence; interpretation errors happen precisely because the counselor lacks training.
3. Become competent first or refer to a qualified colleague
   E.2.a limits counselors to the tests they are trained and competent to use, so the counselor either becomes competent first or refers the testing to someone who is.

A counselor seeks peer consultation about a difficult case. According to the ACA Code of Ethics, what information should the counselor share?

1. The client's name, to allow follow-up questions later
   Naming the client to make follow-up easier puts convenience above confidentiality; consultation works fine with a de-identified case.
2. Relevant details without identifying information
   ACA B.7.a and B.7.b: consultation reports present only data germane to its purpose, and identifying information is not disclosed without the client's consent.
3. The complete client record and test results
   Handing over the complete record and test results exceeds what consultation needs; the standard is relevant information, not everything.

During a video session, a client says she has pills ready to end her life, and then the connection drops. What should the counselor do first?

1. Document the technology failure in the clinical record
   Documenting is required later, but putting it first puts record-keeping ahead of the client's life.
2. Email her safety plan and crisis resources
   An email may not be read in time; sending the safety plan treats an imminent risk as if it could wait.
3. Contact local emergency services at her verified location
   With an imminent suicide risk and lost contact, the counselor uses the location verified at the start of the session and the emergency plan to get local responders to the client.

A client's attorney, who has no training in psychological testing, requests the client's raw test data. According to the ACA Code of Ethics, to whom may counselors release identifying assessment data?

1. Any attorney who sends a written records request
   A written request is not consent and does not make the requester qualified; an attorney without testing training fails the E.4 test.
2. Qualified persons and only with the client's consent
   ACA E.4 permits release of identifying assessment data only with the client's consent and only to persons the counselor recognizes as qualified to interpret it.
3. Anyone the client designates in writing
   Anyone the client designates in writing has consent behind them, which is necessary but not sufficient under E.4; the recipient must also be qualified to interpret the data.

A counselor keeps client records in a cloud-based electronic system. According to the ACA Code of Ethics, what must the counselor tell clients?

1. That only the counselor can technically view the files
   Saying only the counselor can view the files is inaccurate disclosure: cloud vendors, IT staff and billers can have access.
2. Who might access the records and how they are secured
   Counselors tell clients who may have authorized or unauthorized access to electronic records (ACA H.2.b) and how the records are maintained and secured, including encryption (H.5.a).
3. That electronic records are fully immune to breaches
   No system is breach-proof; the code requires acknowledging the limits of technology (H.2.c), not guaranteeing security.

A counselor wants to use a new, developing technique that lacks an established evidence base. According to the ACA Code of Ethics, what must she do?

1. Have clients sign a liability waiver beforehand
   A waiver protects the counselor, not the client; the code asks for informed explanation, and a signature does not replace it.
2. Explain the risks and benefits of an unproven method
   ACA C.7.b allows developing techniques if the counselor explains their potential risks, benefits and ethical considerations to the client and works to minimize harm.
3. Use it just like any well-established technique
   Using it like a well-established technique hides the very fact clients need to know; C.7.a expects a theoretical or empirical basis, and C.7.b adds disclosure for new methods.

According to the ACA Code of Ethics, what is the primary responsibility of counselors?

1. Respecting clients' dignity and promoting their welfare
   ACA A.1.a states it plainly: the primary responsibility of counselors is to respect the dignity and promote the welfare of clients.
2. Protecting the counselor's license and legal standing
   Self-protection is a common real-world motive but not the code's primary responsibility, which faces the client.
3. Achieving measurable symptom reduction for every client
   Outcomes matter, but no code can require a result for every client; this choice turns a goal into a guaranteed duty.

A court-mandated client refuses to sign a release allowing reports to his probation officer. According to the ACA Code of Ethics, what should the counselor do first?

1. Send attendance records to the court without consent
   Sending records without consent breaks confidentiality; the court mandate does not by itself authorize the counselor to disclose.
2. Discuss the possible consequences of refusing
   ACA A.2.e: with mandated clients the counselor explains what will be shared and with whom; if the client refuses, the counselor discusses the possible consequences of refusing.
3. Notify the probation officer of the refusal right away
   Telling the probation officer about the refusal is itself a disclosure without consent; the first step is the conversation with the client.

A 15-year-old client reveals a specific plan to kill herself this weekend and begs the counselor not to tell her parents. What should the counselor do?

1. Notify her parents and arrange immediate safety measures
   A specific plan with a near date is serious and foreseeable harm (ACA B.2.a); with a minor, parents are told and immediate safety steps arranged. How and when to notify follows state law and setting (for school counselors, ASCA standards).
2. Report her parents to child protective services for neglect
   Nothing in the scenario suggests abuse or neglect; a CPS report confuses mandated abuse reporting with the duty to protect a suicidal minor.
3. Keep her confidence to preserve the therapeutic alliance
   Protecting the alliance over the client's life gets the priority backward; imminent suicide risk is an exception to confidentiality.

A 16-year-old tells his school counselor he is gay but is not ready to tell his parents; there are no safety concerns. What should the counselor do?

1. Respect his timing and keep it confidential
   With no safety concern, sexual orientation is the student's private information; disclosure is his decision and his timing (ASCA and ACA confidentiality standards).
2. Urge him to come out to his parents right away
   Pushing him to come out imposes the counselor's view of what is best (ACA A.4.b) and ignores the real risks of coming out before he is ready.
3. Inform his parents at the next conference
   Informing his parents at a conference would out him; parents' rights over a minor do not reach this information when there is no safety issue that would justify disclosure.

A counseling student's unresolved anger repeatedly surfaces in skills role-plays. According to the ACA Code of Ethics, what may counselor educators do?

1. Ignore it as a private matter
   Personal issues become the program's business once they affect competence with clients; ignoring them skips the educator's gatekeeping role.
2. Provide personal counseling to the student
   Counselor educators do not counsel their current students (F.10.e); doing so creates a dual relationship, so they refer instead.
3. Require the student to address the concern
   ACA F.8.d lets counselor educators require students to address personal concerns that could affect professional competence.

In a counseling group, an adult member discloses that her stepfather is currently abusing her 12-year-old sister. What must the counselor do?

1. Make a child abuse report as required by law
   Every state makes counselors mandated reporters of suspected child abuse, and a disclosure of current abuse of a 12-year-old meets the reasonable-suspicion threshold. Timing and agency vary by state.
2. Wait to see whether the member discloses more details
   Reporting is triggered by reasonable suspicion, not proof; waiting for more detail delays protection of the child.
3. Keep it confidential within the group
   Keeping it confidential within the group fails the child: group confidentiality never covers child abuse, and members should hear about this legal exception at the outset (ACA B.2.a, B.4.a).

A counselor's state license is suspended pending a board hearing. What must she do regarding her current clients?

1. Stop practicing and arrange transfer of care
   A suspended license means she cannot practice during the suspension; ethically she still arranges an orderly transfer of clients to avoid abandonment (ACA A.11.d).
2. Continue sessions while appealing the suspension
   An appeal does not restore the license; practicing during suspension is unlicensed practice, whatever the expected outcome of the hearing.
3. Continue with clients as an unlicensed life coach
   Renaming the service does not change it; continuing the same clients as a 'coach' is an attempt to evade the suspension.

A counselor gives a client with a learning disability extra time on a standardized test. According to the ACA Code of Ethics, what must the counselor do?

1. Note the modified conditions when interpreting results
   ACA E.7.a: when an assessment is not given under standard conditions, for example to accommodate a disability, those conditions are noted in interpretation and validity may be qualified.
2. Refuse the accommodation and use standard conditions
   The code expects accommodations for disabilities; the answer to a validity concern is documenting it, not denying access.
3. Report the scores exactly as if standard conditions applied
   Reporting as if nothing changed hides a factor that may affect how the scores compare with the norm group.

During a case conference, a colleague repeatedly refers to immigrant clients as 'illegals.' No client is present. What is the MOST appropriate first step for the counselor?

1. Report the colleague to the ACA Ethics Committee
   The ACA Ethics Committee is also a formal channel; the issue here suits informal resolution first.
2. File a complaint with the licensing board
   A board complaint fits serious or unresolved violations; skipping the informal step is the usual escalation error.
3. Speak with the colleague privately about the language
   Speaking with the colleague privately is the informal resolution ACA I.2.a starts with when a concern can be handled directly and no client is harmed.

A supervisee diagnoses a client's spiritual experience, which is normal within the client's faith community, as a psychotic delusion. What should the supervisor do first?

1. Help the supervisee assess it in its cultural context
   Supervisors address multicultural issues in supervision (ACA F.2.b), and diagnosis must consider culture (E.5.b); a culturally normative experience is not a delusion.
2. Reassign the client to a same-faith counselor
   Reassignment sidesteps the supervisee's training need and assumes only a same-faith counselor can serve the client.
3. Recommend hospitalizing the client for psychosis
   Hospitalization would act on the misdiagnosis itself and could harm the client; the error has to be corrected first.

According to Forester-Miller and Davis's practitioner's guide to ethical decision making, what is the first step?

1. Apply the ACA Code
   Applying the ACA Code is step two of the model; the counselor first has to know what the problem is before checking which standards apply.
2. Identify the problem
   Forester-Miller and Davis (1996, revised 2016) begin by identifying the problem: gathering the facts and sorting out whether the issue is ethical, legal, clinical or professional.
3. Generate possible actions
   Generating possible courses of action comes later, after the problem is identified and the nature and dimensions of the dilemma are determined; brainstorming first skips the analysis.

After three sessions, a client says she wants to stop counseling, although the counselor believes she would benefit from more. According to the ACA Code of Ethics, what should the counselor do?

1. Refuse to release her records until she returns
   Withholding records to pressure a client to return is coercive and conflicts with her right of access (B.6.e).
2. Require her to finish the treatment plan
   Requiring her to finish the plan ignores that counseling is voluntary; the counselor's view that more sessions would help creates no right to keep the client.
3. Respect her choice and discuss options and referrals
   Clients may end counseling when they choose (autonomy); the counselor can share her view, then discuss options and offer referrals.

According to the ACA Code of Ethics, what must counselors explain to clients before an assessment?

1. Its nature and purpose and who will use the results
   ACA E.3.a: before assessment, counselors explain its nature and purposes and the specific use of results by potential recipients.
2. Only the total time the test will take to complete
   Testing time is a practical detail; leaving out purpose and recipients means the client cannot give informed consent.
3. The exact scoring keys used for each of the test items
   Revealing scoring keys would break test security (E.10) and is not what informed consent requires.

A client invites her counselor to her college graduation ceremony. According to the ACA Code of Ethics, how should the counselor approach the invitation?

1. Weigh risks and benefits, consult, and document
   Attending a graduation is a boundary extension: ACA A.6.b asks the counselor to weigh risks and benefits, and A.6.c to document the reasoning; consultation supports the decision.
2. Attend, then end counseling with the client
   Ending counseling after a single benign contact punishes the client for an invitation and abandons treatment; boundary extensions do not require termination.
3. Decline, and tell her such contact is barred
   The code does not ban all outside contact; it asks counselors to judge each extension, so a blanket refusal misstates the rule.

Which legal doctrine holds a clinical supervisor responsible for the negligent acts of a supervisee?

1. Privileged communication
   Privileged communication is a legal protection from disclosure in court; it has nothing to do with who pays for a supervisee's negligence.
2. Vicarious liability
   Vicarious liability (respondeat superior) holds a supervisor legally responsible for a supervisee's negligent acts within the supervisory relationship.
3. Direct liability
   Direct liability is the supervisor's own negligence, such as poor supervision or bad advice; it is not liability for the supervisee's acts as such.

A counselor wants to audio-record sessions for clinical supervision. According to the ACA Code of Ethics, what is required?

1. Nothing extra, as long as the files are encrypted
   Encryption protects stored files but does not replace consent to be recorded at all.
2. Notifying the client after the session
   Notifying the client after the session is notice, not permission; the client must agree before the recording starts.
3. The client's informed consent in advance
   ACA B.6.c requires the client's permission before recording sessions by electronic or other means, whatever the purpose.

A man calls a counselor and asks how his adult son is doing in counseling. The son has signed no release. What should the counselor do?

1. Share information if it would aid the treatment
   Sharing because it might help treatment substitutes the counselor's judgment for the adult client's consent; a possible clinical benefit is not an exception to confidentiality.
2. Share general progress but no specific details
   Sharing general progress still releases confidential information about an adult client; vagueness does not replace consent, which is the trap in this choice.
3. Confirm he is a client but share nothing more
   Confirming he is a client, even while sharing nothing more, already discloses protected information; the error is treating the existence of the relationship as public when only the content seems sensitive.
4. Neither confirm nor deny the son is a client
   Without a signed release, even the fact that someone is a client is confidential (ACA B.1.c), so the counselor can listen but should neither confirm nor deny the relationship. That holds for an adult son whatever the caller's family role.