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(Complete this form if the client is a minor child under the age of 18)

any issues involved in the counseling relationship.  I also understand that a copy of legal custody papers will be required in order to see children from families where divorce has occurred.

The American Counseling Association Code of Ethics states the following:

Inability to Give Consent

When counseling minors or persons unable to give voluntary consent, counselors seek the assent of clients to services, and include them in decision making as appropriate.  Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf.  (Section A.2.d.)

Responsibility to Clients

When counseling minor clients or adult clients who lack the capacity to give voluntary, informed consent, counselors protect the confidentiality of information received in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards. (B.5.a.)

Responsibility to Parents and Legal Guardians

Counselors inform parents and legal guardians about the role of counselors and the confidential nature the counseling relationship.  Counselors are sensitive to the cultural diversity of families and respect the inherent rights and responsibilities of parents/guardians over the welfare of their children/charges according to law.  Counselors work to establish, as appropriate, collaborative relationships with parents/ guardians to best serve clients.  (B.5.b.)

Multiple Clients

When a counselor agrees to provide counseling services to two or more persons who have a relationship, the persons who have a relationship, the counselor clarifies at the outset which person or persons are clients and the nature of the relationships the counselor will have with each involved person.  If it becomes apparent that the counselor may be called upon to perform potentially conflicting roles, the counselor will clarify, adjust, or withdraw from the roles appropriately.  (A.7)

Role Changes in the Professional Relationship

When a counselor changes a role from the original or most recent contracted relationship, he or she obtains informed consent from the client and explains the right of the client to refuse services related to the change.  Examples of role changes include

  1. changing from individual to family counseling, or vice versa;
  2. changing from a nonforensic evaluative role to a therapeutic role, or vice versa;
  3. changing from a counselor to a researcher role;
  4. changing from a  counselor to a mediator role, or vice versa.

Clients must be fully informed of any anticipated consequences (financial, legal, personal, or therapeutic) of counselor role changes.  (A.5.e.)


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