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Professional Ethical Issues and the Development of Professional Ethical Standards in Counseling and Clinical Psychology in China
Mingyi Qian1,2, Jun Gao1, Ping Yao1, Marcus Rodriguez1 
1. Department of Psychology, Peking University, P. R. China
2. Hubei Human Development and Mental Health Key Laboratory, Huazhong Normal University, P. R. China

Correspond to
Mingyi Qian
Department of Psychology, Peking University
Beijing 100871, P. R. China
Tel: 86-10-62751093
Fax: 86-10-62761081
E-mail address: qmy@pku.edu.cn

(Reference:Mingyi Qian, Jun Gao, Ping Yao, Marcus Rodriguez(2009). Professional Ethical Issues and the Development of Professional Ethical Standards in Counseling and Clinical Psychology in China. Ethics & Behavior, 19 (4): 290-309)
Abstract
This paper aims to summarize the current ethical issues in the field of clinical and counseling psychology and the process of developing professional ethical standards in China. First, through a review of the history of counseling and psychotherapy in China, general background information is provided. Important ethical issues are then discussed based on the results from several empirical studies. Finally, the process of developing the new edition of the Chinese Psychological Society Code of Ethics for Clinical and Counseling Psychology, the main contents as well as the considerations taken into account in the development of this code are presented.
Keywords: Ethical Standards, Ethical Issues, Clinical and Counseling Psychology, China
 Ethics are a set of principles concerning appropriate conduct for a group or individual (Corey, et al., 1998). The establishment of ethical standards in the field of psychology serves to protect the interests of people who receive psychological service as well as the professionals who provide these services. The establishment of ethical standards also aims to ensure the healthy development of the profession. 
 In the last thirty years, China’s economy has developed quickly and Chinese society has undergone rapid changes in all aspects of life. Meanwhile, the need for counseling and psychotherapy services as well as the number of people who provide these services has expanded. However, the professionalization of counseling and psychotherapy in China is  still in a preliminary stage of development, this is clearly reflected in the domain of professional ethics. Recently, several efforts have been made by professional organizations to foster the process of professionalization and to develop professional ethical standards as well as a registration system for individual practitioners and professional organizations. 
 Before addressing the main topics of this paper, it is necessary to clarify the relationships between psychotherapy, counseling and psychology in China. The professionalization of counseling and psychotherapy in China faces a complex situation similar to that of many other countries; the key issue is whether counseling and psychotherapy will develop into independent professions or whether they will be treated as a specialty under an already established profession, such as medicine or psychology (Pritz, 2002). Take European countries as an example, clinical psychology and psychotherapy are thought to undergo a differentiation-integration process in the 21st century (Kryspin-Exner & Pal-Handl, 2003), some countries try to treat counseling and psychotherapy as a specialty under clinical psychology or medicine, such as Holland (Hutschemaekers & Oosterhuis, 2004), and other countries try to separate these fields by legalizing psychotherapy as an independent profession, such as Austria (Pritz, 2002). 
 As in many other countries, the Chinese government and professional organizations are now two major forces promoting the professionalization of counseling and psychotherapy; however, these two forces take rather different stances in China. It was only in the early 1990s that some professional organizations were founded and began to play a role in facilitating the development of counseling and psychotherapy in China, and it was not until 2002 that the Chinese government began to regulate the field. By holding two different national examinations and evaluation systems and by issuing separate certificates, the Chinese government seems to be trying to establish counseling and psychotherapy as two distinct professions. Only medical doctors are allowed to apply for the national exam for psychotherapist; psychotherapy is thus regarded by the government as a subspecialty under the field of medicine. The certification exam for counselors, on the other hand, is offered to individuals who is a college or junior college degree in psychology, education, medicine, philosophy, journalism, society, etc (see Table 1 for a detailed description of this certification exam) and complete a short-term government authorized career training course. This seems to imply that counseling and psychotherapy are regarded as distinct professions by the Chinese government. 
 In the past decade, professional organizations in the field of psychology have been trying to regulate the practice of counseling and psychotherapy by establishing them as specialties under the sub-discipline of clinical and counseling psychology. It is by no means an easy task. To make the situation more complex, currently “psychologists” do not belong to a legally recognized profession in China. Although the Chinese Ministry of Education of the People’s Republic of China legally recognizes the academic discipline of psychology, there is no national certification exam or registry system to recognize psychologists. 
 The final point needed to be addressed is the relationship between counseling psychology and clinical psychology. In some countries, such as the United States, counseling psychology and clinical psychology are distinct disciplines within the broader field psychology, and professionals who practice psychotherapy or/and counseling often belong to different professional organizations. However, in China efforts have been made to combine the two into one sub-discipline within psychology and professional organizations do not make any distinctions either. 
 Thus this paper will aim to provide a general picture of the current professional ethical issues in counseling and psychotherapy, mainly through the eyes of clinical and counseling psychologists in China. Nevertheless, it should be noted that those who are now practicing psychotherapy or counseling in China have many different educational backgrounds other than counseling and clinical psychology. It is hoped that this paper will reflect how Chinese professionals strive to develop ethical standards to regulate professional behaviors and fight for their professional status. 
 Accordingly, this paper first provides a review of the history of counseling and psychotherapy in China and previous efforts to develop ethical standards in China. Then, based on the findings of some empirical studies concerning professional ethics in China, important professional ethical issues will be reviewed and discussed under three themes: a) general ethical awareness, ethical violations and dilemmas; b) culturally-specific ethical dilemmas and violations and c) ethical decision making. In the third part of this paper, the process of developing professional standards and the main content of the newly developed Chinese Psychological Society (CPS) Code of Ethics for Clinical and Counseling Psychology will be presented. Finally, the authors discuss the major considerations in developing ethical standards as well as the future challenges faced by Chinese professional organizations and individual practitioners in the domain of professional ethics.         
 
History and Background
The History of counseling and Psychotherapy in China

 The development of counseling and psychotherapy in China witnessed several ups and downs. The psychoanalytic theories were first introduced to China in the 1910s and articles on psychoanalytic theories and techniques, such as dream analysis and free association, were introduced in a few books published in the 1910s and 1920s. In the 1930s, articles promoting the use and describing the principles of behavior therapy to formulate the treatment of psychological disorders were published (Chen & Qian, 1997). Also in the 1930s, counseling and psychotherapy clinics appeared in cities such as Chongqing, Beijing and Shanghai; however, these efforts were hampered during the Anti-Japanese War period (i.e., during the World War II).
 After the People’s Republic of China was founded in 1949, a few cases using behavior therapy to treat patients were reported in the 1950s (Chen & Qian, 1997). However, due to the fact that China was greatly influenced by the former Soviet Union, all approaches and schools from Europe and the United States were distained and rejected, no real progress was made in counseling and psychotherapy. From the late 1950s to the early 1960s, psychologists cooperated with psychiatrists to develop a Rapid Comprehensive Therapy for the treatment of neurasthenia, which was proved to have good effects (Li et. al., 1958; Wang, 1961). These efforts inspired interests in psychotherapy in and among professional circles, but this line of development was again halted because of the Cultural Revolution in China (1966-1976). During this 10-year period, psychology was criticized as being “pseudoscience” and the condition for developing counseling and psychotherapy became even worse. All attempts to develop counseling and psychotherapy were halted.    
 Although the theories and methods of western psychotherapy were introduced into China quite early, a genuine understanding and application of these theories and methods did not begin until the 1980s. Since then, theories and methods of almost every major approach to psychotherapy have been introduced into China. From the early 1980s to the mid 1980s, counseling and psychotherapy clinics gradually appeared in major cities throughout China. The field witnessed its first wave of expansion from the late 1980s to the early 1990s, during which time the number of articles related to clinical and counseling psychology published in Chinese professional journals rapidly increased; the quality of those articles also improved. Meanwhile, the number of people who received counseling and psychotherapy and the number of therapeutic theories and approaches used also increased (Chen & Qian, 1997). Counseling and psychotherapy clinics were established in colleges, universities and hospitals in many cities around China, several professional centers for counseling and psychotherapy emerged and some professionals established their own private practices. Moreover, several professional committees of counseling and psychotherapy were founded during this period in China, and one of them was under the Chinese Psychological Society (CPS) and another was under the Chinese Association for Mental Health (CAMH). Both organizations are registered under the Chinese Science and Technology Association and are legally recognized by the government. The Chinese Psychological Society is a counterpart to the American Psychological Association, and the majority of the members of CPS either has a Master’s degree or a Ph. D. in psychology or has at least obtained the title of assistant professor in psychology at a college or university. Only a few members are medical doctors with a Master’s degree or a Ph. D. in medical psychology. The members of the Chinese Association for Mental Health have more diverse educational and career backgrounds, including psychologists, medical doctors, educators, journalists and so on. In fact, anyone whose work is related to the field of mental health and is willing to accept the statutes of the association can apply for membership. These two organizations are not exclusive to each other, so professionals working as counselors and/or psychotherapists may be members of both organizations. With the establishment of these two professional organizations, professional and academic activities in this field became more organized and the academic atmosphere improved.  
  Beginning in 2002, the field of counseling and psychotherapy entered the phase of professionalization. At this phase, it witnessed rapid growth in all areas. As mentioned previously, the government issuing regulations and certificates for counselors and psychotherapists was the landmark event for this phase of development. In 2001, the Chinese Ministry of Labor and Social Security began to draft out the qualification regulations for counselors. A national occupational criteria for counselors was issued and published on 2002 and later revised and republished in 2005 (CMLSS, 2002, 2005). The first national examination for the certification of counselors was held in 2003. In 2002, the Chinese Ministry of Health and the Ministry of Personnel invited experts in the field to set up qualification regulations for professionals who practice psychotherapy. The first qualification examination for psychotherapists was held on October, 2002. Table 1 lists the prerequisites and minimum qualifications for counselors based on the national occupational criterion for counselor (Chinese Ministry of Labor and Social Security (CMLSS), 2005).
 
 Table 1: Major Contents of the Chinese National Occupational Criterion for Counselor
Put Table 1 About Here
 The participation of the Chinese government in regulating the field as well as promulgating related policies does help to promote the development of counseling and psychotherapy in China; however, two major problems remain unresolved. The first problem is that the training courses required in order to receive a counselor certificate are insufficient, in length and content, to train qualified counselors. Second, according to the qualification regulations issued by the Chinese Health Ministry for professionals who practice psychotherapy (Specialist Group for National Examination for the Certificate for Professional Technique in Health Occupation, 2003) a medical degree is listed as a prerequisite to become a certified psychotherapist. As a result, people who have other educational backgrounds, particularly clinical and counseling psychologists, are excluded from obtaining legal rights to practice psychotherapy; this may limit the development of the field of psychotherapy.   
  Over the course of the past several years, the number of people who have received related professional training has reached more than 100,000. Results from a recent survey study involving 1543 professionals who practice counseling and psychotherapy in 29 cities in mainland China (Qin et al., 2008) may reflect the general qualifications of those who currently practice counseling or/and psychotherapy in China. The average age of these professionals was 36.09 ± 8.81. Nearly 80% of the professionals who participated in this investigation either hold a bachelor’s degree or master’s degree; however, educational levels vary significantly across different parts of the country. For example, there is a high percentage of professionals who hold master’s degrees in the South West and South Central regions of the country, whereas the percentage of professionals who hold junior college degrees is higher in the North West regions. As for their educational backgrounds, 34.8% majored in psychology, 25.3% majored in medicine, 17.4% majored in education, and 19.5% come from other backgrounds. The percentage of professionals in this sample who participate in supervision and self-experience is generally low, 26.5% and 25.3% respectively. Nearly 50% of professionals  have participated in some forms of case discussion. Although it is clear that these professionals still lack appropriate training, the general qualification of professionals has significantly improved since the 1980s and 1990s. 
 In another study, Zhao & Neng (2003) searched both Chinese and international articles on psychotherapy. The Chinese articles, published from 1981 to 2000, were collected using the Chinese Biological and Medical database and the international articles, published from 1981 to 1999, were collected using the Medline database.  Zhao & Neng (2003) then compared the results of these articles and concluded that although there were significantly fewer Chinese articles, the field of psychotherapy in China has indeed experienced a period of rapid growth since the 1990s.

The Development of Ethical Standards in Clinical and Counseling Psychology in China
 
 When founded in 1892, the American Psychological Association did not establish any ethical standards for its professionals.  Ethical complaints from patients and practitioners facilitated the formation of the APA Ethics Committee, as well as the development of the APA code of ethics (Zhao & Ji, 2003). Most of these ethical standards refer to the professional work in clinical psychology and psychological counseling. In confirmed cases of ethical violations, different levels of warnings are given for minor offenses, and a professional’s license to practice may be suspended or revoked for severe offenses.
  The development of the code of ethics for the psychology profession in China is similar to that in the U.S. However, it should be noted that no ethical standard has been developed pertaining to the entire field of psychology in China and this situation may be related to the fact that psychologist is not a legally recognized profession in China and no  specific working areas have been delineated for Chinese psychologists. As a discipline, the development of psychology is similar to the development of counseling and psychotherapy in China. It was not until the end of the Cultural Revolution that colleges and universities began to reestablish psychology as a formal academic discipline. The Peking University Department of Psychology, founded in 1978, was the first department of psychology in the People’s Republic of China. For a long time, there were only four psychology departments in China; this number slowly increased to over 20 in the 1990s. The number of departments and schools of psychology at universities and colleges in China began to surge in this century; according to a non-governmental estimate (personal communication), at the end of 2008 there were 224 subspecialties, departments or schools of psychology in China.
  By the end of 1980s, some professionals proposed that professionals who practiced counseling and psychotherapy should be regulated. As a result, the Chinese Psychological Society (CPS) and the China Association for Mental Health (CAMH) commissioned the Committee of Medical Psychology under CPS (At the time, this was the only committee related to the field of counseling and psychotherapy in CPS, as CPS did not have its own clinical and counseling psychology committee until late 1990s)  and the Committee of Psychotherapy and Counseling under CAMH to draft regulations for professional certification for counselors and psychotherapists. These two committees began to prepare this draft in 1988. After reviewing the ethical standards of professional organizations in the United States, the United Kingdom, Hong Kong and other countries, in 1990 a group of professionals including Mingyi Qian, Zhonggen Chen, Xintian Li, Zhenyun Wu, Youwen Zhao, Youxin Xu and Youbin Zhong, completed this draft, which was comprised of less than 2000 Chinese characters. In fact, this daft was both a code of ethics and a regulation for the professional certification process. Unfortunately, this draft has never been officially enacted in a real sense.
 After another 4-year effort and some minor revisions, this draft was finally published in 1993 in the professional journal of Chinese Psychological Society (CPS & CMHA, 1993). Besides this draft, a code of ethics concerning the use of psychological tests (the 1993’s draft did not include regulations on how to use psychological tests) was published in the same issue. These two publications were the first formal publications concerning professional ethical standards for psychologists in China.   
 In 1999, another attempt to develop professional ethical standards was made by several professionals who practiced counseling and psychotherapy with support from the China Association for Mental Health. Based on a revision of the former draft, a new “code of ethics for professional counselors and psychotherapists” and new “regulations for the registration of professional counselors and psychotherapists” which took into consideration the state of counseling and psychotherapy in China at that time were issued. The 1999 code of ethics consists of five sections: general principles, professional responsibilities, professional relationships, confidentiality, and organization and management. Compared to the former draft, the 1999 ethics code listed more concrete and detailed regulations for professional ethical behavior. For instance, this code of ethics stated that professionals should not discriminate against a client because of race, nationality, gender, religion or values. It also prohibited professionals from forming dual relationships with clients.  
 Although the content of this edition was more comprehensive and more implementable compared to the former draft, it was never put into practice; it was only discussed by members of the China Association for Mental Health and distributed to local divisions of the association for educational purposes. 
 Despite setbacks and frustrations, members of these two committees did not give up. Their unremitting efforts together with the call from the academic field for the regulation of the field of counseling and psychotherapy finally led to the issuance3 of the “National Occupational Criteria for Psychological Counselors” by the Chinese Ministry of Labor and Social Security and the establishment of the professional title of “psychotherapist” as a medical specialty under the supervision of the Chinese Ministry of Health. 
 The “National Occupational Criteria for Psychological Counselors”, which was published by the Chinese Ministry of Labor and Social Security in 2002 (CMLSS, 2002) and then revised and republished in 2005 (CMLSS, 2005), as well as the reference books for the national examination for certification of psychotherapists recommended by Chinese Ministry of Health (SGNECPTHO, 2003) all contain some information related to professional ethical issues. However, the coverage is very limited and no concrete ethical standards or related regulations are mentioned in those documentations or books. For instance, in the latest edition of the “National Occupational Criteria for Psychological Counselors” (CMLSS, 2005), only four ethical standards are mentioned: (1) Respect the rights of the client; (2) Promote the psychological and physical well-being of the client; (3) Respect the privacy of the client and do not reveal his/her personal information to the public; (4) Establish a professional relationship with the client based on the principle of equality and do not establish other forms of relationship with the client (CMLSS, 2005).

Current Ethical Issues in China
 As stated earlier, over the course of just a few years, more than 100,000 people have received training for the national psychological counselor certificate. However, there are very few advanced education programs for clinical and counseling psychology at universities and professional training is usually very brief. Due to the lack of professional ethical standards in psychology in China, courses on ethical standards are scarce and usually last no more than 10 hours in most training programs. In 2005, the Department of Psychology at Peking University offered a course on professional ethical standards in clinical psychology, which, up until this point, is the only clinical psychology program at a university level to offer such a course. At the end of 2006, Ji and Zhao (2006) published a book titled “Ethical Issues in Counseling and Psychotherapy”. Though this book is limited in volume and is based on ethical standards in psychology in the U.S., it is the first book on professional ethics in the field in China. 
 In order to get a general picture of the professional ethical issues in China, the authors searched the key words “psychotherapy”, “counseling” and “professional ethics” for related literature published from 1999 to 2008 in the Chinese Professional Journal Data Base. Nearly 30 articles related to professional ethics in counseling and psychotherapy were found, over 80% of which were published after 2005. Nearly half of the articles were introductions to and discussions of professional ethical principles based on codes of ethics in western countries (e.g. Li & Qian, 2007; Zhao & Ji, 2006). One third of the articles focused on the discussion of ethical standards and violations related to specific therapeutic methods or therapeutic conditions, such as ethical issues related to crisis intervention (Luo & Xiao, 2007), or ethical issues related to internet counseling (e.g. Wu et. al., 2006). There were only 4 survey-based articles related to ethical awareness and attitudes among Chinese professionals. There were no empirical studies concerning professional ethics.          

General Ethical Awareness, Ethical Violations and Dilemmas 
 

 Several survey-based and interview-based studies were conducted among professionals in China to explore general ethical awareness, incidences of ethical violations and features of ethical dilemmas faced by Chinese professionals.     
 Zhang et. al. (2007) used a survey developed by Gibson and Pope (1993) to conduct a study on 145 Chinese counselors and psychotherapists. These professionals were either attendees at an international psychotherapy workshop or a national congress on counseling and psychotherapy held during May and June of 2006. Participants’ ages ranged from 23 to 65 and 65.5% were female. The majority of participants held a bachelor’s degree (51.4%), 38.6% held a master’s degree and 7.1% held a doctor’s degree. Nearly half of the participants (44.8%) were school teachers, 33.8% worked in hospitals and 8.3% were private practitioners. The purpose of the original survey of Gibson and Pope (1993) was to explore whether American counselors understand and support the ethical code of the American Counseling Association; thus the survey is based on seven ethical principles of the ACA Code of Ethics. Five-hundred-and-seventy-four American counselors participated in the survey. All of the participants were registered NBCC counselors. Participants’ ages ranged from 35 to 50 and 51% were female. The majority of the American participants (67%) held a master’s degree and the rest held a doctor’s degree.  Zhang et al. (2007) compared the Chinese and American professionals’ results, and found that compared with Chinese professionals, a larger number of American professionals regarded the survey items to be ethical behaviors. As reflected in this survey, Chinese professionals demonstrate a strong awareness of professional ethics, but they require more training in regards to the issue of confidentiality. For instance, compared with American participants, a larger number of Chinese participants regarded “to not inform the client of the aim of psychological assessment”, “to record a session without acquiring consent from the client” and “not to inform the client of exceptions to confidentiality” to be ethical behaviors. Moreover, the comparison may reveal some cultural differences related to professional ethical behaviors. For example, compared with Chinese participants, a larger number of American participants regarded “to address the client by his/her given name without using his/her family name”, “to allow the client to address the counselor by his/her given name without using his/her family name”, “to shake hands with the client” and “to embrace the client” as ethical behaviors. The authors argue that these differences perhaps say more about cultural differences than they do about ethical awareness, because some interpersonal manners which are widely accepted in America are regarded as inappropriate in China, and vice versa.  
 In another article, these authors used data from the same sample to compare results between Chinese professionals who work in universities and schools and physicians who work in hospitals (Zhang et. al., 2008). Statistical analysis revealed that the responses of the two groups only differed in 14 out of 88 items. The authors argue that, in regards to professional ethical beliefs and awareness, there is little variance between these two groups. Specifically, Zhang et. al. (2008) found that compared to hospital physicians, a larger number of professionals from schools settings seem to be more willing to get involved in the private lives of their clients outside the counseling room; for example, psychological professionals who work in schools regarded “to participate in a special activity of the client (such as wedding)” (45.5% vs. 21.1%) and “to send a holiday greeting card to a client” (61.8% vs. 31.9%) to be ethical. School based professionals in China also seem to be more willing to actively protect the rights of the client, as they regarded “to help clients disclose a colleague’s unethical behavior” (67.3% vs. 40.7%) as ethical. Hospital based professionals, on the other hand, seem to be more willing to “keep boundaries” and stress the importance of payment in counseling and psychotherapy services. For instance, a larger number of physicians regarded “may stop counseling or therapy if the client cannot pay the bill” (52.7% vs. 29.1%) and “to utilize one’s job situation to transfer clients to one’s private practice” (20.4% vs. 7.3%) to be ethical. The authors argue that these differences might be due to the differences between the general working situations of the two groups. Professionals who work at schools are teachers and are usually more emotionally involved in their clients’ lives, which may put them at higher risk of developing dual relationships with their clients.  Professionals who work at hospitals are physicians and thus tend to behave more like a doctor, rather than a counselor or psychotherapist, in their clinical practice (Zhang et. al., 2008).      
 In a recent survey, Li and his colleagues (2007) investigated the ethical issues that face sports psychologists. Three different questionnaires for athletes, coaches and sports psychologists were developed based on a literature review. Six hundred and forty athletes, one hundred and twenty coaches and forty trainee sports psychologists completed surveys. The most prominent ethical problem reported by athletes (38.8%) was: “the counselor breaks the rule of confidentiality and reveals the content of counseling to one’s coach”; for coaches (74.2%) it was: “the athlete’s behavior force one to interfere in his/her privacy”; and for counselors (72.5%) it was: “administrative staff or managers intervene in counseling”.
 Qian, Deng, Gao and their colleagues (Qian et. al., 2006; Deng et. al., 2008) conducted semi-structured interviews concerning professional ethics with 48 professionals. The ages of these professionals ranged from 25 to 68; and 62.5% were female. Participants’ clinical experience ranged from 6 months to 22 years; 27.1% had less than 5 years of clinical experience, 48.0% had clinical experience ranging from 5 to 10 years and the rest had more than 10 years of working experience. Participants’ weekly clinical workload ranged from 2 to 25 hours, with an average of 6.00 hours. Among these professionals, 39.58% hold a doctoral degree, 39.58% hold a master’s degree and 18.75% hold a bachelor’s degree. About one third of the professionals were teachers, 25% were psychiatrists and another one third was counselors. Four types of questions were explored in the interview: (a) cases of ethical violations they have heard of or witnessed; (b) cases of ethical dilemmas they have faced; (c) issues that should be included in a code of professional ethical standards in China; and (d) issues they regard as important when establishing professional ethical standards in China. Interviews were audiotaped, transcribed, and coded for content analysis (Qian et. al., 2006; Deng et. al., 2008).
 It was found that all 48 professionals reported having heard of or witnessed cases of violations of ethical standards. These cases are mainly in the following five categories: (1) Professional relationships, including sexual and non-sexual dual relationships: For instance, some professionals were reported to engage in sexual relationships with their clients, or to utilize their status as therapists to sexually harass their female clients, or to marry their clients. Regarding non-sexual dual relationships, some professionals were reported to become friends with their clients, or to have non-professional contact (such as having dinner with one’s client) with their clients. (2) Privacy and confidentiality: Some professionals were reported to record therapy sessions without permission from the client, or to divulge their clients’ private details to the media or the public. (3) Assessment and evaluation: Some professionals were reported to conduct unnecessary assessments in order to increase their income, or to provide clients with assessment results without any explanation or to label children using results from intelligent tests. (4) Professional competency: For example, conducting certain assessments or practicing a certain therapy without proper training. (5) Research and publication: Such as deception or plagiarism. 
 In addition to cases of violations of ethical standards, all 48 professionals also reported having experienced ethical dilemmas or conflicts in their practice. Some common dilemmas include: (1) Professional relationships:  The greatest of all in this category is the dual relationship situation they experienced in their supervision, training or teaching experiences. Another prominent dilemma they face is associated with receiving gifts from clients. (2) Confidentiality: The most common dilemma occurs when the professional ethical confidentiality regulations conflict with organizational rules or administrative mandates. Another prominent dilemma reported by interviewees is whether to break confidentiality in cases where a client is at risk for suicide. (3) Laws and regulations: Due to lack of specific laws and regulations in China, such as laws on child protection, professionals cannot take proper steps to protect children if they encounter cases of child abuse or neglect in counseling
 In summary, according to these studies, Chinese professionals in general still lack knowledge of and training in professional ethics, especially in regards to professional relationships and confidentiality.  Cases of ethical violations and ethical dilemmas are far from uncommon. Some professionals do not realize they violate professional ethical standards and they do not know how to seek help when facing an ethical dilemma (Deng, et. al., 2008; Qian, 2006; Qian et. al., 2006; Zhang et. al. 2007, 2008).

More Culturally-specific Ethical Dilemmas and Violations
 
 As mentioned above, ethical violations and dilemmas in the category of dual relationships and confidentiality seem to be the most salient problems faced by Chinese professionals. This phenomenon may be related to the collectivistic nature of Chinese culture where forming and keeping an “interpersonal network” is emphasized. This emphasis on interpersonal relationships may create extra challenges for professionals to maintain ethical boundaries with one’s client and thus may lead to ethical dilemmas or even ethical violations related to professional relationships and confidentiality. Two studies have examined how Chinese culture may have distinct influence on professional ethics in related to professional relationships.  
 Gao et. al. (2008) used a questionnaire based on the 2005 American Counseling Association Code of Ethics to examine and compare practitioners’ and clients’ attitudes and beliefs toward professional ethics in counseling and psychotherapy. The same 48 professionals who participated in the semi-structured interview study conducted by Qian et al. (2006) also participated in this survey. The clients were from two counseling centers at a university in Beijing; their average age was 24.5 years, 45.8% were male, and 64.6% were university students. It was found that the items that were most controversial for clients and the items where clients and professionals demonstrated the most significant differences were all items related to confidentiality and professional relationships, especially dual relationship issues. Almost half of the clients in this sample (what %) consider it ethical to form dual relationships with their therapist. The authors propose that there are two possible reasons for these results. First, as shown in former studies and ethical reports from other countries (Cottone, 2000; Gottlieb, 1994; Nigro, 2004), counselors are most vulnerable to ethical dilemmas and even ethical complaints in issues related to professional relationships and confidentiality. For example, in the ACA Ethics Committee annual reports from 2001 to 2002, the top two categories of informal complaints were confidentiality and professional relationship (Sanders & Freeman, 2003). Second, the result might reflect the influence of Chinese culture on shaping professional ethical behaviors and dilemmas. The authors argue that because of the importance of “face” and interpersonal relationships in Chinese culture, Chinese clients tend to accept and even appreciate forming relationships with their therapist that go beyond the professional relationship. Chinese clients often actively seek this kind of dual relationship by sending gifts, inviting professionals to dinners, or asking their acquaintances to introduce professionals to provide them with counseling services. Since Chinese professionals are familiar with these interaction patterns and principles, it might be difficult for them to recognize the ethical implications of these behaviors and thus may be more likely to experience ethical dilemmas and emotional conflicts under these circumstances. 
 Qin et. al. (2008) conducted a scenario-based study on one of the prominent ethical dilemmas faced by Chinese professionals in counseling and psychotherapy, namely, the giving and receiving gifts. The gift-culture in China is based on tradition, which goes back thousands of years and is widely regarded as an acceptable way of expressing gratitude, kindness, friendship and respect among Chinese people. It is also seen as an important means to establish and maintain a relationship connection. Thus, this cultural tradition may pose extra pressure for counselors and therapists to behave in an ethical way when dealing with the dilemma of receiving a gift from a client. In the study, the authors explored whether two groups of objective factors may affect a professional’s response to a gift: the characteristics of gifts and the characteristics of receivers. One hundred Chinese professionals who participated in an international congress on psychotherapy in China in 2007 completed a 26-item questionnaire. The characteristics of the gift examined in this study include: the timing (i.e., when the gift was sent), the price of the gift, the nature of the gift (e.g. cheap handmade card vs. an expensive picture pained by a renowned painter), the person who gives it and gender of the client. Participants’ demographic variables include age, gender, therapeutic approach, education background and length of clinical experiences. It was found that professionals’ decisions about whether they would accept a gift are significantly influenced by the characteristics of the gift. For example, a handmade gift from a client at the end of the therapeutic process would be most likely to be accepted by the professionals. However, the characteristics of the professionals have little influence on whether he/she would accept a gift from a client; these results differs from similar studies conducted in western cultures (e.g. Gibson & Pope, 1993), The authors argue that there may be other individual characteristics that are more influential, such as the degree of identification and acceptance of the Chinese traditional cultural values of “face” or ren qing (interpersonal relationship and mutuality). 
 
Ethical Decision Making
 
 Another ethical issue worth examining is the decision making process in ethical dilemmas.
 In the survey done by Zhang et. al. (2007), participants were asked to choose the basis for their decision making process when faced with an ethical dilemma. It was found that 76.6% of professionals chose “professional training” as their reference, 62.9% chose “personal common sense” and 27.6% chose “professional books and journals”. The other bases for decision making listed by participants include: one’s clinical experience, therapeutic approach, conscience, personal beliefs, laws and regulations, intuition and lessons learned by one self or from colleagues. 
 In a recent study, Li & Qian (2008) investigated 156 counselors and therapists on their professional ethical values and how they make decisions in ethical dilemma scenarios. The average age of the participants was 37.67 (± 9.38) and 64.7% were female. The majority of the professionals held a bachelor’s degree (41%) or a master’s degree (41%). Participants were first asked to rate the importance of ethical values in a 7-point Likert scale. They were then asked to read six ethical dilemma scenarios and rate whether they think this particular behavior is ethical and which ethical principle they would choose as the basis for their judgment. Participants were presented with three types of scenarios: a) a client tries to contact the professional outside of the session, b) the rise of the payment by the professional, and c) an acquaintance tries to introduce a client to the professional. Thirteen ethical values are included in the study; nine of the values were adapted from a study conducted by Jennings & Skovholt (2005). The authors summarized the nine ethical values held by master herapists of America. These nine values include: relational connection, autonomy, nonmalefience, competence, humility, professional growth, openness to complexity and ambiguity, and self-awareness. The other four values were general principles listed in the new CPS code of ethics: responsibility, integrity, justice and respect. The study found that Chinese professionals tend to give very high ratings on all ethical principles; the top three ethical principles rated by these professionals included respect, responsibility and justice. However, their ratings of ethical values fail to predict the result of their decision making process in ethical dilemma scenarios. These results are not consistent with a study conducted by Jennings & Skovholt (2005). The authors then used a semi-structured interview to explore how therapist’s ethical values influence their decision making in professional ethical dilemma situations as well as other potential factors that might influence their decision making. Sixteen professionals participated in this interview study and eleven were female. It is found that Chinese professionals tend to hold bidirectional explanations in a single ethical value. For instance, professionals who rate a certain behaviors as unethical might judge the same behavior as ethical in their real practice situation and list the same ethical principle as the basis for their judgments. They also may use a certain strategy to bypass the dilemma. For instance a dilemma mentioned by an interview was one of her colleagues asking this professional to do counseling for her child. Although the interviewee regarded it unethical to do counseling for this child, she did not want to decline her colleague’s request. Because this refusal would impair the relationship between her colleague and her since in Chinese culture, not doing such a “favor” for one’s colleague was regarded as being inconsiderate and selfish. A strategy she used to bypass this dilemma was to see the child for a general interview and then transferred the child to another professional. By using this strategy, this interviewee managed to behave ethically while abiding by the common rule of “ren qing” in the Chinese society (Li & Qian, 2008). The authors argue that this finding partly explains why the scores of professional ethical values could not predict the way professionals make ethical decisions; it may also reflect the dialectic thinking style emphasized by the Chinese. Finally, these results indicate that professionals who have not received formal training in professional ethics use their own intuition or personal beliefs to make decisions in ethical dilemma situations and their decision making strategies are situationally specific. 
  In conclusion, as can be seen from the literature review and discussion above, many Chinese professionals report encountering ethical dilemmas in their daily work and ethical violations are frequently heard of or witnessed. Chinese professionals also find it difficult to make ethical dilemma decisions and may use their personal experience or intuition as the basis for decision making. This is partly because there have been no specific ethical standards for professionals to follow (the CPS code of ethics was only recently published in 2007) and structured training opportunities in professional ethics and conduct have been very limited. Another possible reason is the influence of Chinese culture, especially its emphasis on interpersonal relationship networks, mutuality and reciprocality, as well as hierarchy and respect of authority, which are all salient features in collectivistic cultures such as China. These cultural values may collide with ethical principles and standards that are widely accepted in individualistic cultures like the United States or European countries, such as respecting and promoting the client’s autonomy, keeping clear boundaries and avoiding dual relationships, as well as the importance of confidentiality in the therapy. Thus, it is especially difficult for Chinese professionals to follow certain principles or standards that are widely accepted in individualistic western cultures; furthermore, pressures from Chinese cultural norms and traditions may bring about ethical dilemmas and even violations. This hypothesis is partly confirmed by the literature review in this section. However, further empirical research is needed to clarify how certain cultural norm or characteristics influence ethical behavior, such as the dual relationship issue and the ethical decision making process.    

The Development of the Chinese Psychological Society Code of Ethics for Clinical and Counseling Psychology
The Background and Process of the Development of CPS Code of Ethics 
 

 In order to solve the current problems in the professional field of psychology, to ensure the interests of clients and professionals and to further promote the development of clinical and counseling psychology in China, it is essential to develop a code of ethics to regulate the professional field.  
 This mission was first conceived in 2004 and a formal plan began to take shape in 2005. From 2005 to 2007, under the direct leadership of the Executive Committee of the Chinese Psychological Society, three workgroups, each with distinct responsibilities, were set up. The first group works on the development of professional ethical standards as well as the establishment and implementation of a registration system for clinical and counseling psychology professionals and organizations; the second group works on registering professional organizations and individual practitioners; and the third group works on implementing the professional ethical standards. The third workgroup is also responsible for explaining ethical standards, checking the ethical conduct of individual practitioners and professional organizations that apply for registration, filing ethical violation complaints, and processing cases of ethical violations.  
 Based on a review of international literature, as well as the advice from local and foreign professionals, two important documents were drafted by the three workgroups: the “Chinese Psychological Society Registration Criteria for Professional Organizations and Individual Practitioners in Clinical and Counseling Psychology” (CPS, 2007a) and the “Chinese Psychological Society Code of Ethics for Clinical and Counseling Practice”(CPS, 2007b). These two documents were unanimously approved by the CPS Executive Committee on February 5th, 2007. 
 Mingyi Qian, Xiangyi Chen, Zhijin Hou and Ming Li are key members in the CPS workgroups to develop the CPS code of ethics. Before drafting the CPS code of ethics, group members reviewed related documents of American Psychological Association, American Counseling Association, American National Association of Social Workers, American Association for Marriage and Family Therapy, Britain Psychological Society, Canadian Psychological Association, European Association of Psychotherapy, and documents of professional organizations in Hong Kong and Taiwan areas (AAMFT, 2001; ACA, 2005; APA, 2002; BPS, 1995; CPA, 2000; EAP, 1997; HKPS, 1998; NASW, 1996; Taiwan Legislation Council, 2001; Taiwan Chinese Counseling Association, 1990). Meanwhile, the group members also reviewed the related Chinese research in the field. Based on these reviews and through repeated discussions, the draft of the CPS code of ethics took shape. This draft was then put on the website of CPS to collect opinions and suggestions among professionals from mainland China and Hong Kong area. In addition, the members of three workgroups were assembled for four times to discuss this draft and several revisions were made before the final edition of the CPS code of ethics was approved unanimously by the executive committee of CPS.

The Main Contents of the Chinese Psychological Society Code of Ethics for Counseling and Clinical Practice (2007)
 
 The main content of CPS code of ethics contains the preamble, the general principles and the ethical standards. The preamble explains the aim of this code of ethics, that is, to “help all the clinical and counseling psychologists, those who seek professional services and the general public to achieve a better understanding of the core ideas of the professional ethics as well as professional responsibilities in the field of counseling and psychotherapy practice. It serves as an ethical guide designed to guarantee and promote the standards of the service provided in the field of counseling and psychotherapy practice. It helps to guarantee the rights and interests of those who seek professional service as well as that of all the clinical and counseling psychologists. It helps promote the mental health status and enhance the welfare and wellbeing of the general public, so as to facilitate the development of a harmonious society. This Code of Ethics applies for all the clinical and counseling psychologists registered in CPS and thus serves as a basis for processing ethical complaints and inquiries initiated against those who register as a clinical and counseling psychologist in CPS.” (CPS, 2007b)
 The general principles consist of five principles: beneficence, responsibility, integrity, justice and respect.
 The part of ethical standards contains 7 sections: professional relationship, privacy and confidentiality, professional responsibility, assessment and evaluation, teaching, training and supervision, research and publication and resolving ethical issues.
 The section of professional relationship includes 12 articles concerning conducts such as informed consent, dual relationship, intimate relationship and payment. It forbids professionals to take advantage of their professional status to satisfy their own interests. It also defines the appropriate relationship between professionals and their colleagues as well as professionals from other field. 
 The section of privacy and confidentiality includes 7 articles concerning the confidentiality in professional work and its limitations and exceptions. It also refers to the regulation on conducts such as the preservation and usage of case record, assessment materials, tapes and videos. 
 The section of professional responsibility includes 8 articles on the requirements of professionals for further education and supervision. It emphasizes the importance of self-care among professionals. It requires professionals to keep an open, honest and accurate attitude when describe themselves and their services when facing the public or in the media. 
 The section of assessment and evaluation includes 6 articles that require professionals to receive proper training before using any assessments and not to misuse any assessment tools.      
 The section of teaching, training and supervision includes 7 articles that require professionals to keep an honest, serious and responsible manner when teaching, conducting training and doing supervision. It emphasizes that the aim of teaching and supervision is to elevate the professional competency of students and supervisees. It also emphasizes the importance to keep a professional relationship with students and supervisees. It requires professionals to give honest and fair evaluations to their students and supervisees. It forbids professionals to take advantage of their professional status to satisfy their own needs. 
 The section of research and publication includes 9 articles that require professionals to respect the interests of their research participants as well as that of those who make contribution to the research. It forbids unnecessary deception and plagiarizing. 
 The section of resolving ethical issues includes 8 articles that provide a framework of how to resolve conflicts when facing ethical dilemma as well as how to file complaints about ethical violation. 
 Compared with the 1999’s code of ethics, the new CPS code of ethics changes the structure of the code into three parts by adding a preamble and separating the general principles with the sections of ethical standards. For the general principle part, the new code lists five general principles and their explanations instead of four articles concerning observing law and regulations, promoting one’s own mental health, promoting one’s competence and knowing one’s limitations in the old edition. For sections of ethical standards, three sections from the old edition are kept: the professional responsibility, the professional relationship, and confidentiality, but in the new code, the old articles are revised and new articles are added for each section. Four new sections are added: assessment and evaluation, teaching, training and supervision, research and publication, and resolving ethical issues. 
 Table 2 compares the structure and the main contents of Chinese Psychological Society Code of Ethics for Counseling and Clinical Practice (2007) with American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (2002) and American Counseling Association Code of Ethics (2002). 
 
 Table 2: The Comparison among CPS-Clinical (2007), APA (2002) and ACA (2005) 
Put Table 2 About Here
 As seen in the table 2, the general principles of CPS code of ethics are more similar to that of APA code of ethics while the sections of ethical standards are more similar to that of ACA code of ethics. This is due to the nature of CPS code of ethics for it is a code of ethics for clinical and counseling psychology and it serves to regulate those professionals who practice counseling and psychotherapy. However, although the CPS code of ethics is much more concrete and detailed than the 1999’s edition, if compared with the code of ethics of APA or ACA, its length is still very short and the content is not as comprehensive and concrete as that of ACA code of ethics. For instance, the counseling relationship section in ACA code of ethics contains 12 main articles and each main article contains 4 to 8 sub-articles while the professional relationship section in CPS code of ethics only contains 13 main articles with no sub article. There is also no article related to specific therapeutic conditions, such as end-of-life care for terminally ill clients or technology-assisted service. Nevertheless, although the articles of CPS code of ethics may still be too general, it is indeed a code of ethics that reflects the current situation in China and is thus feasible under the current situation in China. This point will be further discussed in the next section.

The Major Considerations in Developing Ethical Standards  
 
 Two major considerations were taken into account in the development of this new CPS code of ethics. The first consideration was whether it would reflect the current situation in the field and the second was whether it could be practically implemented to the current situation in China. 
 For the first consideration, when developing concrete articles in different sections, the workgroup members not only made themselves familiar with ethical standards of other international professional organizations, but also paid special attention to whether those articles were feasible under the situation in China. For instance, when drawing the article on referring a client to other professionals in clinical practice, based on the similar articles in other professional organizations in Western countries, it was required that professionals in clinical and counseling field should contact with the professionals from other fields. However, during the further discussion, it was noticed that a good communication network between professionals from different fields had not yet been developed in China. Thus, this article would not be fully implemented under current situation in China. This requirement was then omitted. Instead it is only emphasized in the new article that psychologists should form an active and cooperative relationship with their colleagues and professionals from other fields (see in article 1.12 and 1.13). 
 In addition, since in Chinese culture, professionals tend to be regarded as authority by both clients and professionals themselves, it is stipulated in this new code of ethics that “clinical and counseling psychologists should respect the personal values of those who seek professional service. They should not make decisions for those who seek professional service or impose their own values on those who seek professional service” (see in article 1.5).     
 For the second consideration, the workgroup members decided to take a two-step procedure when developing the standards. The first step was to set up a broad framework which included basic ideas of ethical standards. The second step was to add more concrete articles. This two-step procedure was based on the fact that the former two drafts of ethical standards issued by Chinese Psychological Society and China Association for Mental Health were rather short and simple. The newly developed code of ethics is more than tripled of that of the edition in 1999 despite it is only a broad framework. Moreover, considering the fact that no ethical standard has ever been implemented in this field in China, it will take a great amount of work as well as a long period of time to educate professionals, let alone implement it in a real sense. It is agreed among the members that further improvement will be done when time is right. 
 
Future challenges and Directions 
 
 The development and the implementation of professional ethical standards are closely related to the development and the implementation of a registration system for clinical and counseling psychology.  
 Over 200 professionals in the field of clinical and counseling psychology in China are now registered as counseling and clinical psychologists or supervisors. Further improvements will be made to build the website of the registration system and to improve the online services (the website of the registration system is: http://www.chinacpb.org/). Criterion for the counseling and clinical psychologists and organizations registration system and code of ethics as well as the name lists of registered counseling and clinical psychologists and supervisors are published on the website. Those who have passed the evaluation procedures and become registered professionals are required to abide by the CPS codes of ethics for counseling and clinical practice. 
 In the future, efforts will be made to improve the management of the registration system. As to the domain of professional ethics, future work directions include:
 a) To conduct training courses and workshops on the CPS code of ethics for registered counseling and clinical psychologists as well as supervisors. Several such workshops on ethical standards in counseling and clinical psychology led by Mingyi Qian and Zhijin Hou were held in a few cities like Beijing, Shanghai and Kaifeng in Henan Province.
  b) To educate a group of qualified teachers and trainers in clinical psychology and counseling psychology and to design a curriculum based on the articles concerning graduate training programs in counseling and clinical psychology listed in the “CPS Registration Criteria for Professional Organizations and Individual Practitioners in Clinical and Counseling Psychology”.
 c) To compile reference books on the CPS codes of ethics with clinical case illustrations, and to publicize and promote the implementation of the CPS Code of Ethics for Counseling and Clinical Practice.
 d) To conduct empirical studies on professional ethics in counseling and psychotherapy, especially on ethical dilemmas and ethical decision making processes that reflect the influence of culture on Chinese professionals, which may provide important references for revising the CPS code of ethics and training courses on professional ethics in the future. 
 e) To publicize the registration system among professionals and the public on a larger scale so as to facilitate the understanding of this registration system as well as the CPS code of ethics. Efforts will also be made to gain acknowledgement from the government for this registration system and to influence related legislation at the state level if possible. 
 It is hoped that the new registration system and ethical standards in counseling and clinical psychology will gain influence within the professional field in China and help promote the healthy development of the profession as a whole.

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 Endnotes
1Project supported by the philosophy and social science grant (05JZD00031) from the Ministry of Education of the People’s Republic of China; and supported also by the funds for Hubei Human Development and Mental Health Key Laboratory (Grant No. 200705) of China.
2 The evaluation process for the second and the third level of the National Certificate for Counselor are open for the public, that is to say, anyone who has fulfilled the prerequisites can apply for the national exams of the two levels and is able to receive the national certificate if he/she passes the exam. However, the evaluation process for the first level has never been held officially. No one has ever received the certificate of this level. The reason for suspension is not clear. 
3The draft and the issuance of the “National Occupational Criteria for Psychological Counselors” was mainly an effort by experts from the Chinese Mental Health Association and they were invited by the CMLSS, responsible for drafting and final issuance of the document. As to the establishment of the professional title of “psychotherapist”, the Chinese Ministry of Health commission the Chinese Mental Health Research Institute to set up a group of experts in the field to draft the related documents and the first author of this paper was one of them.

Table 1: Major Contents of the Chinese National Occupational Criterion for Counselor
Level Third  Second First
Prerequisite  (1) Those who hold a bachelor’s degree or above in psychology, education or medicine
(2) Those who hold a junior college degree in psychology, education, or medicine and have completed the recognized training courses for this level 
(3) Those who hold a bachelors degree in other subjects and have complete the recognized training courses for this level
(1) Those who hold a doctoral degree in psychology, education or medicine
(2) Those who hold a masters degree in psychology, education, or medicine and have completed the recognized training courses for this level 
(3) Those who have obtained a Level III Counselor Certificate , have been practicing counseling for at least three years and have completed the recognized training courses of this level
(4) Those who have secondary position or above in psychology, education and medicine,  have been practicing counseling for at least three years and have completed the recognized training courses for this level 
(1) Those who hold a doctoral degree in psychology, education or medicine, have been practicing psychotherapy for at least three years and have completed the recognized training courses for this level  (2) Those who hold a masters degree in psychology, education, or medicine, have obtained a Level II Counselor Certificate , have been practicing counseling for at least three years and have completed the recognized training courses for this level 
(3)Those who have senior position in psychology, education and medicine, have been practicing counseling for at least three years and have completed the recognized training courses for this level 
Length of Recognized Training  Courses 500 hours 400 hours 300 hours
Evaluation Procedure (1) Pencil and paper theory exam (120 minutes)
(2) Pencil and paper practical exam  (120 minutes)
(1) Pencil and paper  theory exam (120 minutes)
(2) Pencil and paper practical exam (120 minutes)
(3) Interview (30 minutes)

 
(1) Pencil and paper theory exam (120 minutes)
(2) Pencil and paper practical exam (120 minutes)
(3) Interview (30 minutes)

 
Basic Competence (1) Preliminary diagnosis
(2) Individual counseling
(3) Able to implement basic psychological tests and questionnaires
(1) Diagnosis using information from ICD-10 and case formulation 
(2) Individual counseling and group counseling
(3) Able to implement psychological tests and questionnaires, and providappropriate explanation of the results 
(4) Able to provide basic training and clinical demonstration for level III counsellor
(1) Diagnosis using information from ICD-10, case formulation, and consultation for difficult cases 
 (2) Individual counseling, group counseling and crisis intervention
(3) Able to implement, revise and develop psychological tests and questionnaires (including projective tests), as well as providappropriate explanation of the results
(4) Able to provide training and supervision for level III and level II counsellors 
Open for application2 Yes Yes No
Table 2: The Comparison among CPS-Clinical (2007), APA (2002) and ACA (2005)

 
CPS-Clinical(2007) APA(2002) ACA(2005)
Structure  3 Parts:
Preamble
General principles
Ethical standards
4 Parts: 
Introduction and applicability
Preamble
General principles
Ethical standards
3 Parts:
Preamble
Purpose
Ethical standards
General Principles 5 Principles:
Beneficence
Responsibility
Integrity
Justice 
Respect 
5 Principles:
Beneficence and nonmaleficence
Fidelity and responsibility
Integrity
Justice
Respect for peoples rights and dignity
/
Ethical Standards 7 Sections:
Professional relationship
Privacy and confidentiality
Professional responsibility
Assessment and evaluation
Teaching, training and supervision
Research and publication
Resolving ethical issues
10 Sections:
Resolving ethical issues
Competence 
Human relations
Privacy and confidentiality
Advertising and other public statements
Record keeping and fees
Education and training
Research and publication
Assessment
Therapy
8 Sections:
The counseling relationship
Confidentiality, privileged communication,
and privacy
Professional responsibility
Relationships with other professionals
Evaluation, assessment, and interpretation
Supervision, training, and teaching
Research and publication
Resolving ethical issues

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