Our+Take+on+Ethical+Termination+in+this+Case+at+Hand




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“Counselors are often faced with situations which require sound ethical decision making ability. Determining the appropriate course to take when faced with a difficult ethical dilemma can be a challenge. To assist ACA members in meeting this challenge, the ACA Ethics Committee has developed A Practitioner's Guide to Ethical Decision Making. The intent of this document is to offer professional counselors a framework for sound ethical decision making. The following will address both guiding principles that are globally valuable in ethical decision making, and a model that professionals can utilize as they address ethical questions in their work.”

** Below is how our group used the process for making ethical decisions recommended by the ACA to design and ethical plan for termination in the case of Steve and Christine. ** To navigate this page:flat

=**I. Identify the problem: A Case of Ethical Termination **= = =

 Personal: Problems the counselor may face himself

 * Steve separating his feelings regarding the tenants of Judaism from his counseling relationship with Christine.
 * Steve's experience of the Jewish faith
 * Steve's prior experiences with interfaith relationships clouding his judgement
 * Steve's defensive nature regarding the Jewish faith and Jewish people

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;"> Client: Problems regarding Christine

 * <span style="font-family: Arial,Helvetica,sans-serif;">Christine's lack of understanding of Jewish Culture
 * <span style="font-family: Arial,Helvetica,sans-serif;">Christine's ability to handle Jeremy's parents without hostility
 * <span style="font-family: Arial,Helvetica,sans-serif;">Is Christine willing to compromise or convert
 * <span style="font-family: Arial,Helvetica,sans-serif;">No real plan for the future in regards to how she and Jeremy are going to make faith decisions in regards to holidays and <span style="font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">what faith their children will be raised in.

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Workplace: Problems regarding Steve’s place of employment

 * <span style="font-family: Arial,Helvetica,sans-serif;"> Supervisor failed to recognize the level of Steve’s resentment toward Christine.
 * Supervisor did not advise Steve of his legal and ethical responibilities to Christine
 * <span style="font-family: Arial,Helvetica,sans-serif;"> Supervisor fails to protect client

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Legal: Any legal problems Steve may face

 * <span style="font-family: Arial,Helvetica,sans-serif;"> Is Steve’s treatment of Christine discrimination
 * <span style="font-family: Arial,Helvetica,sans-serif;">Could Steve’s continuation rather than termination of the counseling relationship with Christine be considered insurance fraud.
 * <span style="font-family: Arial,Helvetica,sans-serif;"> If Steve chooses to terminate could it be considered discrimination based on his refusal of services due to Christine's religious background.

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Ethical: Ethical dilemmas related to this situation

 * <span style="font-family: Arial,Helvetica,sans-serif;">Did Steve properly inform Christine about her insurance coverage prior to beginning counseling relationship
 * <span style="font-family: Arial,Helvetica,sans-serif;">Should Steve continue to counsel Christine
 * <span style="font-family: Arial,Helvetica,sans-serif;">Should Marvin, Steve’s supervisor, step in to protect client
 * <span style="font-family: Arial,Helvetica,sans-serif;">At what point is Steve crossing the line in regards to forcing his beliefs and values on the client.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Does continuing sessions cause harm to the client?

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<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Apply the ACA Code of Ethics
> <span style="font-family: Arial,Helvetica,sans-serif;">ACA Code of Ethics standard A.1.a (Primary Responsibility) states “The primary responsibility of counselors is to respect the dignity and to promote the welfare of clients.” In the discriminatory ways Steve treated Christine, and in how he imposed his own values onto her so fervently, he was not promoting her welfare or respecting her dignity. He was not trying to help her solve her problems, but he was using her to further his own agenda that religious intermarriage is wrong. > <span style="font-family: Arial,Helvetica,sans-serif;">Steve the counselor violated ACA Code of Ethics standard A.11.a (Abandonment Prohibited) which states “Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.” In reading this case, it was apparent that Steve gave Christine little help because he was prejudiced in his views on religious intermarriage. It can be argued that Steve abandoned Christine as a client from the very beginning when he made a treatment goal that was not inline with what Christine wanted or needed out of counseling. Steve also did not supply Christine with appropriate arrangements for the continuation of treatment after depleting her insurance coverage. > <span style="font-family: Arial,Helvetica,sans-serif;">Another ACA Code of Ethics standard violated in this case is A.11.b (Inability to Assist Clients). A.11.b states “If counselors determine an inability to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors should discontinue the relationship.” According to this code, it would have been more ethical for Steve to discontinue his relationship with Christine as soon as realized that he could not move past his prejudice and own world view enough to be an effective counselor for Christine. He should have recognized his inability to help Christine and sent her to another counselor rather than depleting her insurance coverage trying to achieve his own goals. > <span style="font-family: Arial,Helvetica,sans-serif;">ACA Code of Ethics Standard A.11.c (Appropriate Termination) states “Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling. Counselors may terminate counseling when in jeopardy of harm by the client, or another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Counselors provide pre-termination counseling and recommend other service providers when necessary.” Steve violated this code by terminating counseling with Christine without having provided pretermination counseling, previously discussing the limits of Christine’s insurance coverage, and recommending suitable other service providers. > <span style="font-family: Arial,Helvetica,sans-serif;">ACA Code of Ethics standard A.11.d (Appropriate Transfer of Services) states that “When counselors transfer or refer clients to other practitioners, they ensure that appropriate clinical and administrative processes are completed and open communication is maintained with both clients and practitioners.” This code comes into play because Steve should have transferred Christine’s counseling services earlier on by referring her to another practitioner. He should have done this after taking note of his strong, negative reaction to Christine, and the recognition of his own agenda to encourage Christine to except Jeremy's parents view that marrying a Jewish man was wrong. > <span style="font-family: Arial,Helvetica,sans-serif;">Steve violated ACA Code of Ethics standard A.4.b (Personal Values), which states “Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants.” From the moment Steve decided that his goal in counseling Christine was to convince her to end the engagement, he was breaching this ethical standard. Steve personally believed that non-Jews and Jews should not get married, had a strong reaction to Christine, and could not help but interject his personal values into the therapeutic process. > <span style="font-family: Arial,Helvetica,sans-serif;">A.4.a (Avoiding Harm) states “Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm.” By using up Christine’s insurance coverage and not helping her with her problem since it was against his values, Steve undoubtedly inflicted harm on Christine. Now, she has used up her insurance coverage, received little to no help along they way, and will have trouble affording another counselor who can actually help her move forward > <span style="font-family: Arial,Helvetica,sans-serif;">ACA Code of Ethics standard C.5 (Nondiscrimination) applies greatly to this case. C.5 states that “Counselors do not condone or engage in discrimination based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital status/partnership, language preference, socioeconomic status, or any basis proscribed by law. Counselors do not discriminate against clients, students, employees, supervisees, or research participants in a manner that has a negative impact on these persons.” By treating Christine in a way that was not helpful to her, and imposing his own religious values on her, Steve was discriminating against Christine’s religion/spirituality. > <span style="font-family: Arial,Helvetica,sans-serif;">ACA Code of Ethics Standard F.1.a (Client Welfare) states that "A primary obligation of counseling supervisors is to monitor the services provided by other counselors or counselors-in-training. Counseling supervisors monitor client welfare and supervisee clinical performance and professional development. To fulfill these obligations, supervisors meet regularly with supervisees to re- view case notes, samples of clinical work, or live observations. Supervisees have a responsibility to understand and follow the ACA Code of Ethics." Marvin, Steve's supervisor, violated this standard by not doing more to ensure that Steve was keeping his personal values out of his counseling relationship with Christine. After Steve told Marvin that there was an issue here, Marvin should have monitored Christine's welfare more closely. > <span style="font-family: Arial,Helvetica,sans-serif;">ACA Code of Ethics Standard F.4.c (Standards for Supervisees) states that "Supervisors make their supervisees aware of professional and ethical standards and legal responsibilities. Supervisors of post-degree counselors encourage these counselors to adhere to professional standards of practice." Marvin violated this ethical code by not taking greater measures to ensure that Steve understood the ethical and legal implications of discriminating against Christine in the way he did. Marvin could have done more to help Steve understand why he is feeling how he is feeling and how to avoid letting his personal reactions influence the counseling process.
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">A.1.a. Primary Responsibility ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">A.11.a. Abandonment Prohibited ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">A.11.b. Inability to Assist Clients ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;"> A.11.c. Appropriate Termination ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">A.11.d. Appropriate Transfer of Services ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">A.4.b. Personal Values ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">A.4.a. Avoiding Harm ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">C.5. Nondiscrimination ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">F.1.a. Client Welfare ===
 * ===<span style="color: #008080; font-family: Arial,Helvetica,sans-serif;">F.4.c. Standards for Supervisees ===

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=<span style="color: #008000; font-family: Arial,Helvetica,sans-serif;">II. Consider the Principles and Virtues =

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">How Moral Principles Apply to the Case at Hand
<span style="font-family: Arial,Helvetica,sans-serif;">A large part of Steve’s moral development undoubtedly came from his Jewish upbringing. The Jewish faith obviously plays a large role in Steve’s life and his religious beliefs have a strong influence on his feelings and behaviors, especially in this case. Judaism is similar to Christianity and Islam in its depiction of morality. Some of Steve’s religiously d <span style="font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">ictated moral principles are probably: dedication to the ideal of justice, altruism, kindness, advocacy for human rights, compassion, humility, respect for tradition, and respect for elders. Many of the moral principles that Steve has within him apply to the case at hand and probably cause Steve to feel conflicted. He probably feels like he should be just, respectful, kind, and altruistic in his treatment of Christine, but he also feels an obligation to respect Jewish law as it relates to interfaith marriage and to respect elders, in this case Jeremy's parents. It is likely that Steve feels Christine is not respectful of Jewish traditions or her potential future in-laws and has a negative reaction to her since endorsing her marriage to a Jewish man conflicts with his religious beliefs and some of his moral tenants.

<span style="font-family: Arial,Helvetica,sans-serif;">As a professional counselor, there are moral principles Steve most likely has adopted. These are respect for autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity. While many of these principles are in line with his religious morals, he is certainly not paying due diligence to respecting Christine’s autonomy, nonmaleficence, and beneficence in this case.

Ways that the Moral Principles compete with Each Other
<span style="font-family: Arial,Helvetica,sans-serif;">In this case, Steve’s moral principles of autonomy, nonmaleficence, and beneficence are competing with those of respect of Jewish tradition and respect for elders. Unfortunately, autonomy, nonmaleficence, and beneficence have lost the competition and have caused Steve to act unethically. A solution to this could be for Steve to create a priority rank system of the moral principles battling inside him.

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Priority Rank of Moral Principles
<span style="font-family: Arial,Helvetica,sans-serif;">When he is acting as a professional counselor, it is important for Steve to remember that the moral principles he has adopted as a counselor need to have a higher priority than his religiously dictated moral principles. This does not mean that his religious moral principles do not deserve a place since many of his religious moral principles are wonderful and undoubtably make him a better counselor in one way or another. But, when a client has values that conflict with his religious morals, he should be able to see the clients situation from their perspective and make sure that employing his moral principles benefit his client and not only himself. In this case, it is our belief that Steve’s moral principles should have been prioritized as below:

<span style="font-family: Arial,Helvetica,sans-serif;">1) Respect for Autonomy - Christine is an adult and is entitled to make her own decisions regarding marriage. <span style="font-family: Arial,Helvetica,sans-serif;">2) No-maleficence - Steve is unable to respect Christine's autonimous decisions. Does he needs to take steps to refer her to another counselor to ensure that her counseling experience does not harm her? <span style="font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">3) Altruism - Steve should be willing to sacrfice his feelings towards interfaith marriage in order to provide appropriate counseling for Christine <span style="font-family: Arial,Helvetica,sans-serif;">4) Fidelity - Steve should be faithful in his sepration of his ideals and beliefs from the counseling session <span style="font-family: Arial,Helvetica,sans-serif;">5) Justice - Steve must treat all clients justly regardless of their religious beliefs or respect for his faith <span style="font-family: Arial,Helvetica,sans-serif;">6) Veracity - Steve should have been more truthful about his counseling relationship with Christine when discussing it with his supervisor

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">How Virtue Ethics Apply to the Case
<span style="font-family: Arial,Helvetica,sans-serif;">Virtue ethics, those which ask “Who should I be?,” also play into this case. Steve probably has two sets of virtue ethics in competition with each other. One set depicts the kind of counselor he strives to be, and the other set that depicts the kind of Jewish man Steve strives to be. To get a grip on these virtue ethics, Steve needs to take a look at who he is instead of focusing on what he is doing. Steve can examine his ideals and define the kind of human being he aspires to be as a helping professional. Steve should think about aspiring to have integrity, discernment, acceptance of emotion, self-awareness, and interdependence with the community. If Steve stops and thinks about the kind of counselor he aspires to become, perhaps he will realize that the way he is treating Christine is not helping him to reach this goal.

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Effect of Any Possible Actions on Steve’s Sense of Moral Selfhood
<span style="font-family: Arial,Helvetica,sans-serif;">Steve should have been more mindful of the conflicting elements of his moral selfhood battling each other in this case. If he would have thought about it, he probably could have seen that being an ethical counselor to Christine and resisting the urge to impose his values on her was congruent with his moral identify as both a religious person and a professional counselor. Being respectful of Christine’s beliefs and promoting her best interests instead of his own would have promoted Steve’s moral selfhood and enhanced his moral development while not doing so only set him back.

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= III. Tune in to Your Feelings =

What Emotions Steve is Experiencing as he Contemplates the Situation and His Possible Actions
When Steve first realized that he had a negative reaction to Christine he should have taken a step back after the session, taken a few deep breaths, and assessed his emotions. Perhaps he felt insulted or overwhelmed. He felt a strong affiliation to Christine's potential future in-laws to the point that the text states he sided with them. He even might have been feeling dislike towards Christine. Regardless of what he was actually feeling, he should have been mindful of his emotions and taken time to process them. If he gains understanding of his emotions and where they stem from he will be more capable of keeping them in check in his future sessions with Christine and set them aside in order to benefit her. Taking inventory of his emotions might be something Steve has to do during and after every session with Christine. He will have to work hard to remain mindful that his emotions exist and insure that they are not seeping into the therapeutic relationship.

To What Extent is Steve Being Influenced
Steve should take time to think about what is influencing his negative reaction to Christine. Is it is religious beliefs? <span style="font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">It is important to understand that the laws written in the Torah are not considerd moral or ethical guidelines. The laws of the Torah must be obeyed for no reason beyond the fact that they reflect the will of God. It is not clear what sect of the Jewish religion Steve is afiliated with but, in some sects the defiance of the laws recorded in the Torah is believed to bring eternal consequences. Steve level of influence is probably related to the sect he adheres to. Is Christine describing a situation similar to one that has impacted his own life? Is there any transference occurring between he and Christine resulting from previous experiences? If Steve can not seperate his religious beliefs from his counseling practice he may need to consider counseling through referral from Jewish temples in the area or making sure clients are aware that he is operating with a faith based approach. I think if Christine had been informed that he was a faith based counselor and his Jewish sect was fundamentalist she would have sought counseling elsewhere.

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= IV. Consult with Colleagues or Experts =

An important and imperative part of making an ethical decision as a professional counselor is to consult with colleagues, supervisors, or experts. Consulting with others can allow one to step outside of their box or the singular way in which they see the problem, and appreciate other viewpoints and opinions which are important to incorporate in making a well rounded, ethical decision. While Steve did discuss his reaction to Christine with his supervisor, he was not honest with his supervisor about how much he was letting his personal issues with Christine impact the way counseling her was going. Steve should have been honest with himself and his supervisor and had a long in depth discussion about how he can keep his personal values out of the therapeutic relationship and if referring Christine to another counselor is the best course of action since she does have insurance limitations. Perhaps Steve should have even taken time to seek out and consult with Jewish colleagues that might be better able to identify with the way he is feeling. Regardless, Steve should have found someone or more than one person with whom he could discuss his feelings and issues with Christine with. If Steve was honest with them, colleagues would have been able to help him identify his feelings, understand that he is acting unethical, and provide feedback onto how he can turn things around and do best by his client.

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= V. Involve the Client in the Decision-Making Process =

In this case, involving Christine in the decision-making process could have taken a number of forms. One thing Steve definitely should have done is to have had a discussion with Christine about the limits of her insurance plan. She should have known from the very beginning that her insurance would only cover ten sessions. Steve should have checked in with Christine throughout the counseling process about whether or not she was happy with the content and direction of counseling and allowed her to have imput on the direction to proceed in. Also, Steve and Christine should have been discussing referral alternatives for her to seek out after her coverage ended prior to the last session. Steve should have better prepared Christine for termination. Another way that Steve could have involved Christine in the decision-making process is by disclosing how he is feeling to her. He could have done this in a number of ways but would have had to make sure that his disclosure was sensitive and aimed to be in Christine's best interests. Perhaps if he tried to help her understanfd that Jeremy's parent's objections stemmed from adherance to a religious tenant and not from a judgment of her worth as a wife, she might feel better about the situation. One disclosure that we think would have been appropriate would have been for Steve to disclose his feelings of identification with Jeremy's parents and about his feelings of discomfort with her hostility towards them. Perhaps this disclosure would have allowed Christine to see Jeremy's parents in a different light. Perhaps she did not realize that she was coming off as hostile and insight into this could benefit her. This disclosure might have also led to her reconsidering her choice in counselors which might have been the best option for her.

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= VI. Identify Desired Outcomes =

In our opinion, this case presents two key issues. One of the issues involves ethical termination and the other involves the imposition of personal values. It is our opinion that if Steve were to take time to identify the desired outcomes of this case in an ethical way they would be:

1) If Steve is able to put his personal values aside, help Christine reach mutually agreed upon counseling goals.

2) If Steve is unable to put his personal values aside, refer Christine to a colleague or other professional.

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= VII. Consider Possible Actions =

The next step Steve should embark on is to identify possible actions to reach the desired outcomes. When Steve first met with Christine, his desired outcome was to convince Christine to break-off her engagement. Hopefully, after embarking on the above steps and doing some soul searching Steve will realize that this is an inappropriate outcome and will begin to brainstorm different desired outcomes such as those outlined above and determined how to act to achieve them.

1) If Steve is able to put his personal values aside, help Christine reach mutually agreed upon counseling goals.
If he decides to do the work to keep his personal values and emotions in check and continue to work with Christine in a healthy way, possible actions include: seeking supervision; seeking consultation; consulting with Christine to set goals of counseling; seeking his own personal counseling; working with Christine to help her find peace in her decision to marry Jeremy; helping her to prepare for the difficulties of an interfaith marriage; focus on strengthening Christine and Jeremy's relationship so they are prepared to face the difficulties of a religiously diverse family; suggest referal to family therapist for Christine, Jeremy, and Jeremy's parents; helping Christine learn more about Judaism and find ways she is comfortable incorporating it into her life; and even helping Christine make a decision (where she takes the lead) about whether or not marrying Jeremy is the best option for her. He can also suggest literature to Christine and he can be a helpful and reflective ear for her to share her worries and stresses with so she doesn't feel alone. Part of acting to achieve this outcome will involve ethical termination practices since the course of Christine's treatment is dictated by insurance limitations if she can not afford further services. Steve will have to make sure to offer Christine a number of good alternatives to continue treatment after coverage ends and make sure not to abandon her. In order to offer Christine a number of good alternatives to continue treatment after her coverage ends, Steve will need to take more time to explore the community resources. Perhaps there is religious counseling through a nearby synagogue or church that could be an option. Perhaps there is a community mental health agency nearby that can fit Christine's needs. Maybe there are support groups, personal growth groups, or a lower cost premarital counselor Steve can suggest. These are all options Steve will have to explore to present Christine with good alternatives to continue treatment. Also, i f Steve does continue to see Christine ethically, he will have to make sure to discuss termination well before the last counseling session. He will want to give time for Christine to present the issues most import to her in the remaining sessions, and have time to wrap-up her progress. He will also want to give Christine ample time to process the idea of termination and consider whether or not she wants to continue treatment elsewhere or not.

2) If Steve is unable to put his personal values aside, refer Christine to a colleague or other professional.
If Steve is unable to keep his personal values out of his relationship with Christine, he should take the actions necessary to ethically refer Christine to another professional. These steps include offering Christine a number of other alternatives and giving her the names of other counselors Steve believes will be helpful to her. It will also involve explaining to Christine why he is referring her. We believe that it will be best for Steve to tell Christine that he is referring her to a professional that he believes will be better able to fit her needs or has more experience counseling interfaith couples. While this reasoning is not untrue, it will not lead Christine to feel bad or discriminated against. Steve should also comply with <span style="font-family: Arial,Helvetica,sans-serif;">ACA Code of Ethics standard A.11.d (Appropriate Transfer of Services).

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= VIII. Choose and Act on Your Choice =

Lastly, Steve should combine the work he did in the above two steps by selecting the best outcome that is most congruent with his moral principles and implementing the actions necessary to reach it.

It is our belief that the best outcome for Steve is for him to continue to work with colleagues and supervisors to keep his personal values in check and to continue to see Christine and help her reach mutually agreed upon counseling goals (outcome 1). He will need to implement the previously discussed actions to reach this outcome and continue to acknowledge his feelings, seek supervision, be honest with himself, and say mindful of his reactions and values and whether or not they are entering into the counseling sessions in an unethical way. He will also need to be more proactive in regards to termination and fully explain the limits of her insurance coverage to Christine.

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<span style="font-family: Arial,Helvetica,sans-serif;">Holly Forester-Miller, Ph.D. Thomas Davis, Ph.D. <span style="font-family: Arial,Helvetica,sans-serif;">Copyright © 1996, [|American Counseling Association]. A free publication of the <span style="font-family: Arial,Helvetica,sans-serif;">American Counseling Association promoting ethical counseling practice in service to the public. -- Printed and bound copies may be purchased in quantity for a nominal fee from the Online Resource Catalog or by calling the ACA Distribution Center at 800.422.2648.