The clarity around professional boundaries and ethics is one of the things that drew me to become a mental health therapist.
A few different things play a role in my desire to serve people in a way that has clear ethical guidelines in place. First of all, my brain thrives when the structure and guidelines for an interaction or event are clear. Knowing what is expected (and in some cases, allowed) helps me to show up prepared for therapeutic work. This is just a biological truth about me.
Secondly, my pursuit of graduate studies in mental health counseling began after an experience where vocational and personal boundaries were not very clear nor were they honored. I knew that when I left my role in vocational ministry that I wanted to continue being able to support people, to create opportunities for them to be heard and to grow. I also knew that I wanted to do that in a way that was more holistic and that provided clear ethical boundaries regarding my role and the relationships.
My role as a licensed professional counselor (or Licensed Clinical Mental Health Counselor, as NC likes to refer to us) provides just that – an opportunity to come alongside folks and support them in their own growth and healing journey in a boundaried way that is built on a foundation of clear ethical guidelines. This is something I’ve thought about since my first inklings of considering a return to graduate school almost 15 years ago. Ethics, integrity, and clearly communicated boundaries are part of my core values as a person and as a therapist.
A Side Note…
You may know that one of the areas where I specialize in my work as a therapist is supporting those who have experienced religious harm, including spiritual abuse and religious trauma. If you’ve been around this blog or my social media, you also may know that I do not refer to myself as an “expert” and I believe that title recreates many of the dynamics that often contribute to religious harm (read more about that here).
You may also be aware of news of some recent ethical violations regarding Laura E. Anderson, PhD, a well-known figure in the religious trauma therapy world. While this post is not focused on that story, I think it would be insincere to not mention this. Honestly, these confirmed violations and the ongoing conversation have been difficult for me because of my own lived experience of being harmed by abuses of power, as well as my work in supporting religious trauma survivors. If you want to know more about these specifics, I’ve included a few links at the end of this post.
However, here are a few things I want to make clear in light of this story and the allegations of harm:
- I believe survivors. It is incredibly difficult to come forward and make a report (of any kind) about the misuse or abuse of power, regardless of the contexts. Flint Del Sol, author, trans activist, and former teacher wrote: “If you’ve ever been on the business end of workplace discrimination (or any kind of abuse in which one party holds pretty much all of the power), you know that an essential element is doubt. Did that actually happen to me? Was it a big deal if it did? If I say something, will it all just get worse? Do I even want to bring everything back up again?”
- Licensed therapists have agreed to abide by a clear code of ethics, and there is a mechanism in place for reporting possible violations. These violations are then investigated and result in a decision by the professional licensing board. This process is in place to protect those seeking therapy, and it ensures that complaints about a therapist are handled in a specific manner.
- The coaching profession does not have licensing boards, agreed upon ethical standards, or processes for the reporting and investigation of abuses of power. There are very ethical coaches out there, but this is something to be aware of when seeking support.
- Laura E. Anderson is a human and a survivor of religious trauma herself. She is also a licensed professional who agreed to uphold certain ethical standards. There is likely complexity to these events that we’re not (nor necessarily should be) privy to, and it is important to pay attention if/when there are multiple yellow or red flags related to a particular person or entity.
What are Therapist Ethics?
Ethics are the moral principles that guide a person’s behavior, the way they conduct themselves and engage with others. Many vocational roles, particularly those that involve a professional license such as being a mental health therapist, have a standard set of professional ethics. These professional ethics provide a foundation for practice, and offer specific guidelines to address common areas of the therapist role.
One of the first courses that I took during my first semester in the Clinical Mental Health Counseling program at UNC-Greensboro was entitled “Professional Ethics.” We spent the entire semester learning about the code of ethics for licensed counselors and examining the various ways this code could apply in real-word scenarios. All accredited counseling programs must include a course with a focus on professional ethics.
As a Licensed Clinical Mental Health Counselor (LCMHC; often called a Licensed Professional Counselor in other states), I have to complete at least 40 hours of continuing education every 2 years in order to maintain my professional license. At least 5 of those hours must be related to professional ethics. You can verify the status of an LCMHC license in NC here (other licensing boards and US states have similar sites).
An emphasis on understanding professional ethics and providing services in an ethical way is integral to being a licensed mental health professional – from the earliest part of training to the ongoing continuing education requirements.
Foundational Components of Ethics
The ACA (American Counseling Association) Code of Ethics is the specific guidelines that apply to my role as a licensed mental health counselor. This code is built upon 6 foundational concepts, which interact with one another in ethical decision making. These are described below:
Autonomy – the right of the client, or participant in counseling services, to control the direction of their life. This may include decisions regarding when to seek therapy, what therapist to work with, or the desired type of therapy.
Nonmaleficence – avoiding actions that cause harm. A therapist will not knowingly engage in actions that will definitely, or have a foreseeable likelihood to, cause harm to the client.
Beneficence – working for the good of the individual and society by promoting mental health and well-being. This may include the specific work done in therapy sessions, as well as ongoing work by the therapist to increase overall awareness of topics related to mental health.
Justice – treating individuals equitably and fostering fairness and equality. This may include providing various payment options, being engaged in social justice activities, or assisting an individual in finding a provider who may better fit their needs.
Fidelity – honoring commitments and responsibilities in the professional relationship. This includes things such as being on time for appointments and abiding by the policies outlined in the informed consent document (which should always be provided and reviewed prior to engaging in services with a licensed professional).
Veracity – dealing truthfully with all professional contacts. This includes things like being honest about the potential risks and benefits of therapy and using evidence-based therapy options to support individuals’ healing.
Specific Areas Included in the Code of Ethics
Each code of ethics includes details related to specific areas of practice. The exact wording or logistics may vary a bit depending on the licensing board and location, but there are several areas that are generally included in every code of ethics for mental health professionals.
Some of these areas include:
Informed Consent:
It is the responsibility of the therapist to ensure that information is provided about various aspects of the therapeutic work and relationship. This information should be presented clearly to potential clients prior to beginning therapy, allowing an opportunity for questions and discussion. Informed consent should also continue throughout the therapeutic relationship. Some areas that should be included in informed consent include: pricing for services and expectations regarding payment of fees, scheduling and cancellation policies, communication policies, accurate representation of the therapist’s training / qualifications / specialty areas / scope of practice, and if/when/how diagnoses will be utilized in therapy.
Maintaining Records and Documentation / Confidentiality of Client Information:
Therapists are responsible for creating and maintaining records related to our work with clients. We are bound to maintain the confidentiality of our clients’ information, and only ethically able to break confidentiality in very specific circumstances (which should be outlined for you prior to beginning services). The specifics may vary slightly for the various codes of ethics depending on location and licensing board, but in general it is required that records are kept for all services provided, and that those records are maintained throughout service and remain available for a specified number of years after services end (often at least 5).
Developmental and Cultural Sensitivity / Multicultural Competency:
Another course that I took in my first semester of graduate school was focused on multicultural competency – understanding various aspects of individuals’ identities and how that may impact their life and experience of therapy. Licensed mental health professionals are expected to continue learning about various cultures and experiences, and to actively work to develop and strengthen cultural sensitivity. We are also expected to have awareness of our own biases and knowledge limitations, being competent in providing referrals for other services when needed.
Maintaining Professional Boundaries / Documenting Boundary Extensions:
Every code of ethics includes a section about professional boundaries. This section of each code includes things such as: the therapist does not pursue a sexual or romantic relationship with their clients, we cannot provide therapy for people in our personal lives (friends, family, etc.), and that we are to avoid dual relationships where possible. A dual relationship occurs when the therapist has 2 (or more) types of relationships with a client. The first relationship is the therapist/client relationship. Ideally, there would be no other relationship, but that is not always possible.
For example, a therapist may live in a small town with only one Italian restaurant. The therapist loves the food at that restaurant and frequents it often, but learns that a client is now working at that restaurant. That creates potential for a dual relationship, but not necessarily a harmful one. It is the therapist’s responsibility to consider the potential for harm in continuing to frequent that restaurant.
The therapist may ask both themselves and other ethical colleagues questions such as – Are there other options for Italian food within a reasonable distance? Is it possible to eat at this restaurant without interacting with my client? Have I discussed the possibility of seeing one another in the restaurant with my client? Would other similarly trained licensed therapists make the same decision?
Once the therapist has made a decision regarding any possible boundary extensions (i.e. going beyond the therapist/client role), the therapist is responsible for documenting how that decision was made, their reasoning, any consultation they had with other licensed professionals, and any communication they had with the client about how to handle the boundary extension.
Dual relationships are not completely forbidden within most codes of ethics; however, there must be a reason for any extension of boundaries in relationships and the therapist is responsible for evaluating and maintaining professional boundaries. The ultimate consideration is asking, “Does this have potential to do harm to the client?”
Social Media Presence / Policies:
Social media is a fact of life for many people at this point in history. That includes therapists. Codes of ethics for therapists are (somewhat slowly) adopting official guidelines on how to utilize social media in an ethical way. For me and my code of ethics, this means keeping my personal social media profiles separate from my professional social media profiles.
The accounts associated with my work as a mental health counselor are focused solely on topics related to that work – general mental health, my specialties, upcoming services or events I’m offering, etc. I never share client-specific content online. I don’t “friend” or “follow” former, current, or potential clients on these accounts. I interact with all comments in the same manner in order to protect the confidentiality of any clients who may choose to comment on a post. I, personally, choose not to communicate with former, current, or potential clients via direct message, and instead request that folks contact me via email. I also don’t search out clients’ social media profiles as a way to protect their privacy – if they want to share something with me in session, that is welcome. I have all of this outlined in the informed consent document that folks receive before our first session together, and am happy to answer any questions they may have.
Each professional code of ethics for licensed mental health providers includes many more topics and details than what I’ve shared here. I hope this gives you an idea of some of the topics that are covered and the expectations regarding ethical practice for therapists.
How Do Ethics Apply for a Religious Trauma Therapist?
A professional code of ethics applies to everyone who holds that specific professional license. All licensed social workers are expected to abide by the Social Work Code of Ethics. All licensed mental health counselors are expected to abide by the American Counseling Association’s Code of Ethics. Regardless of the specific license, those who hold a professional license to provide mental health therapy in the US have agreed to practice in an ethical manner, as outlined by their specific code of ethics.
Since I specialize in supporting folks who have experienced religious harm (spiritual abuse, adverse religious experiences, religious trauma, etc.), I want to offer 3 special considerations related to ethical practice as a religious trauma therapist. These areas involve ethics that are always important, but I believe they come with a bit of additional therapist responsibility in supporting survivors of religious harm.
Client autonomy and informed consent.
Many folks who have experienced religious harm were never given an opportunity to consent to experiences or expectations being placed upon them. These experiences can include things ranging from being directed as a child to hug someone even if that person made them uncomfortable to being thrust into witnessing activities without being able to ask questions. Survivors may also have never been allowed autonomy over their body, time, money, or activities. In fact, for many folks their experience included being told they could not trust themselves and that they must look to someone else (the group leader, a higher power, God, etc.) for guidance.
These common experiences make it imperative that a religious trauma therapist emphasizes informed consent and client autonomy. From the first time I communicate with a potential client, I strive to make it clear that this process is collaborative. I am open about what therapy might look like, all the policies in place related to our therapeutic work, and the possible risks and benefits of therapy. I welcome questions about anything related to therapy.
Throughout our time working together, I offer suggestions of how we might approach things and discuss options and preferences with the client. I allow for variety in how they show up and participate in sessions, based on their needs at that time. I believe that part of the healing process is inviting survivors into discussion and decision-making and honoring their autonomy to say “no” or “not right now” or to choose to move in a different direction.
Healing from religious harm often includes understanding what it means to have all the necessary information to make a decision, and to know that you are free to ask clarifying questions. Healing often means getting reacquainted (or acquainted for the first time) with your own autonomy and learning to trust yourself. My work as a religious trauma therapist puts me in a unique position to support this healing through ethical practice.
Communicating and maintaining boundaries.
Boundaries help define where one person ends and another begins. They provide clarity around what responsibilities belong to each individual. Boundaries also allow us to identify our own needs and preferences in order to have authentic relationships with others. Yet, boundaries are rarely, if ever, discussed within high-control religious contexts. Even when they are mentioned, there are often clear implications about which boundaries are actually allowed or acceptable.
Working as a religious trauma therapist means that it’s important for me to have spent time formulating my own boundaries, that I am clear in communicating those boundaries (related to our work together) to clients, and that I uphold any stated consequences for boundary crossing. This not only models for clients what boundaries can look like, it also provides clear expectations about what they can expect from me in our therapeutic relationship.
Honoring client confidentiality.
In many experiences of religious harm, information that was shared in private was not kept confidential. I have known far too many folks who had their private conversations turned into sermon illustrations or information they shared with one person become a group-wide prayer request. While all licensed US therapists are currently bound by HIPAA to maintain confidentiality, honoring that can be even more important for religious trauma therapists.
The world of religious trauma survivors can feel quite small at times. There are often multiple folks who experienced harm within the same group. There are only a finite number of resources and therapists available to support these survivors. So, it’s imperative that religious trauma therapists maintain client confidentiality and protect the stories of those who have already been harmed by a misuse of power.
The harm experienced by many religious trauma survivors involved some misuse or abuse of power. There is an inherent power differential in the therapy relationship. As the therapist, I have specific training and education, I structure the particular therapeutic environment, and I am privy to a great deal of personal information about those I work with. This makes it even more important to be aware of ethical practice guidelines and to take additional steps to ensure those are being implemented in my work as a religious trauma therapist.
Next Steps
For survivors of religious harm…
- If you are located in North Carolina and are interested in working with me, feel free to check out my website for more information about individual counseling and group therapy for survivors. You’re welcome to reach out via this contact form.
- Outside of NC, I encourage you to check out the therapist directories at Reclamation Collective and Empathy Paradigm. Reclamation Collective also regularly offers virtual support groups.
For mental health professionals..
- I provide professional consultation on topics related to working with survivors of religious harm. This may even include specific case consults, always respecting the confidentiality and autonomy of those you support.
- I also regularly provide NBCC-approved continuing education courses on topics related to religious trauma. There is a course specifically focused on ethical practice from a trauma-responsive lens – Religious Trauma & Therapist Power Dynamics – coming up in October 2025.
I hope this post has helped clarify some of the complexities around ethics as a licensed mental health professional, and provided some helpful resources for you to take any next steps as desired.
Resources for “A Side Note..”
- Rick Pidcock’s Initial Article (7/28/25) / Laura E. Anderson’s Response (8/1/25)
- Podcast: The Unlearning Curve – Episode 31 – discussion with Rick Pidcock
- Podcast: Your Therapist Needs Therapy – Episode 108 – 2 therapists discuss ethics
Michelle F. Moseley is a Licensed Clinical Mental Health Counselor in NC. She believes ALL people deserve respect, compassion, and access to mental and physical healthcare. Michelle specializes in working with survivors of religious trauma, and with those who have body image concerns, finding there is frequent overlap in these areas. She also frequently supports late-identified neurodivergent individuals as they navigate the grief and relief of a new understanding of self. You can learn more about Michelle by visiting her website at MichelleFMoseley.com or following her on Instagram – @therapy_with_michelle
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