The Professional Counselor | Volume 12, Issue 2 115 Ethical Considerations It is important to note that counselors should under no circumstances recommend herbal remedies, OTCs, or dietary supplements to clients because doing so would be outside of the scope of their practice (ACA, 2014; Ingersoll & Rak, 2016). The ACA (2014) Code of Ethics specifies that “counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” (Section C.2.a, p. 8). Despite this, professional role boundaries related to psychopharmacology between prescribing physicians and counselors can be unclear at times (Ingersoll & Rak, 2016). For example, clients may ask counselors for advice on medication. So, in addition to keeping abreast of trends in the use of CAMs and OTCs and attending to this during intake and work with clients, developing consultation and referral resources in this area is an important consideration for counselors (Preston et al., 2021). Resources may vary from state to state given differences in licensing and certification of health professionals and general prescribing privileges for psychotropic medications. There are wide-ranging opinions among counselors pertaining to prescribing psychotropic medications to clients (Ingersoll & Rak, 2016). These opinions cannot dictate whether a client is referred to the medical community for medication evaluation. Counselors are ethically obligated to refer clients to a medical professional when necessary, including referrals related to pharmacotherapy as well as non-prescription drugs, herbal remedies, or dietary supplements. Withholding such a referral may constitute malpractice. The ACA (2014) Code of Ethics states that “counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm” (ACA, 2014, Section A.4.a., p. 4) and also specifies that “counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors” (ACA, 2014, Section A.4.b., p. 8). Diversity and Cultural Considerations It is important that counselors are able to discuss racial and cultural considerations with clients to ensure competence and to promote the welfare of clients (ACA, 2014). Our commitment to diversity and inclusion must also be extended to clients who are taking psychoactive substances and herbal remedies. It should be noted that genetic research has found that there are a number of significant differences in terms of drug metabolism, effectiveness, and side effects among ethnic groups (Burroughs et al., 2002). At the same time, race, age, and gender can be crude or flawed yardsticks for predicting responsiveness to drugs; however, counselors do need to be aware that there are significant variations in response to drugs based on multiple factors, and that these variations are more the norm than the exception (Bhugra & Bhui, 2018; Burroughs et al., 2002). Further, racial and ethnic disparities persist in health care, and this may contribute to clients’ decisions to take CAMs and OTCs (Gureje et al., 2015). Less than 6% of active physicians are Hispanic and less than 5% are Black (American Association of Medical Colleges, 2019), even though 40% of Americans are non-White or Hispanic (U.S. Census Bureau, 2020). This can create barriers to obtaining and providing appropriate care, as it has been found that racial or ethnic minority clients are less likely than their White counterparts to receive prescriptions to treat their mental health conditions (Coleman et al., 2016). This inequality may lead clients to seek CAMs or OTCs to treat mental health issues (Coleman et al., 2016; Gureje et al., 2015).
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