Kristin Trick, MA, LCMHC, LPC-S, RPT-S is a therapist in private practice and specializes in the treatment of post-traumatic stress and anxiety disorders. She has worked in the psychiatric hospital, non-profit agency, and private practice settings over the past 10 years.

This is the first installment of "The Ethical Private Practitioner" series. Part 2 covers how to foster long-term resilience as an ethical clinician and practice owner.

“I was so angry I slapped him in the face in front of all his friends at school,” the father of my adolescent client vented. 

The confession wasn’t news to me. His son had shared the details immediately after I’d closed the door for our individual session. The adolescent acknowledged his part in the conflict, as well as the emotional and physical harm his father’s blow had left behind. Aware of the requirements regarding mandated reporting for therapists, I asked my client to wait in the lobby while I spoke privately with his father.

As soon as the door closed, his father freely owned the aggression. My stomach knotted as I processed the implications: a family I’d become fond of was falling apart, and I felt like I was about to make it worse by looping in CPS. Fighting the urge to minimize the father’s confession, I emphasized our ability to improve the relationship through family sessions and stated my obligation as a mandated reporter.

His face grew livid as the last words left my mouth and I envisioned myself as the recipient of his next slap. In that moment, as in many past and since, I wondered, "Am I doing the right thing?"

All healthcare professionals experience doubts about the “right” course of action. We often hesitate when faced with a choice between an easy “wrong” and a difficult “right.” The sections ahead unpack the foundations of ethical decision-making, the realities of mandated reporting, and how clinicians navigate these moments when the right choice feels anything but simple.

Ethical codes exist to guide us through a field laden with uncertainties and liabilities. While specific codes vary between social workers, counselors, psychologists, psychiatrists, and marriage and family therapists, they share a core foundation regarding mandated reporting for therapists:

Beyond the moral obligation, failure to maintain ethical standards can lead to the suspension of your license, legal troubles, and the end of your career.

Ethical breaches in mental healthcare are more common than many practitioners realize, and are also increasingly public. Many state boards publish disciplinary actions online. For example, the North Carolina Board of Licensed Clinical Mental Health Counselors updates public records with violations, including: 

Mainstream news also highlights these failures. For instance, States Newsroom listed multiple clinicians sanctioned by Iowa’s Board of Behavioral Health Professions. These practitioners were found as having inappropriate communication, not keeping proper records, and breaking confidentiality.

When an ethical dilemma arises, your first resource should always be your profession’s national code of ethics. Identify which standards are in jeopardy and review the national board’s recommended procedures. 

Next, consult your specific state licensing board and local government regulations. State laws vary significantly on important details of mandated reporting for therapists, so confirm details such as the definition of a minor, specific reporting protocols for child or elder abuse, and the extent of parental rights. 

Beyond regulations, draw on your professional support network. A supervisor or trusted colleague can share insight from an objective distance to help you make decisions.

After 10 years of counseling work his words are etched into my mind. I document all interactions with clients as if they’re a transcript, following a simple rule: “If you didn't document it, it never happened.” 

When you navigate an ethical dilemma, clearly document:

Write objectively, with the expectation that your client, their insurance provider, or their legal team will eventually review the records. Sign and date all documents and file them in chronological order. Include relevant communications with your client, such as emails and texts.

Also list the contact information for any third parties involved. For example, if you make a CPS report, document the name and ID number of the representative with whom you spoke and the case number given.

I drove home that evening with a mixture of emotions, the largest of which was relief that my client’s irate father had not acted physically on his anger towards me. He’d listened to my explanation that as a Texas-licensed counselor, I needed to formally report any accounts of harm to a child, and then brusquely walked out.

I phoned CPS after he left, gave the agent the details, and recorded the case number in my client’s chart. I assumed I’d be closing the file later that month due to the father’s resentment.

A week later, I was surprised to find both father and son waiting in my office lobby for their regular appointment time. My heart pounded as the father asked if he could speak with me privately. Battling fearful thoughts of what would happen next, I ushered him into my office. 

Once in my office, his anger had vanished. His eyes filled with tears as he said that he never wanted to hit his son again. He requested family sessions to resolve their issues. I agreed on the spot, and over our remaining work together, I witnessed the transformation of their family unit.

Not every ethical dilemma has such a rewarding outcome. However, as practitioners, we must be willing to do the right thing regardless of the consequences.