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in the Mental Health

Gatekeeping

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Figure 1.1

Figure 1.2

Figure 6.1

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Figure 7.2

Printed in the United States of America Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the written permission of the publisher.

American Counseling Association

6101 Stevenson Avenue, Suite 600 | Alexandria, VA 22304

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Digital and Print Development Editor | Nancy Driver

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Cover and text design by Bonny E Gaston

Library of Congress Cataloging-in-Publication Data

Names: Homrich, Alicia M , editor | Henderson, Kathryn L , editor | American Counseling Association, issuing body

Title: Gatekeeping in the mental health professions / Alicia M. Homrich, Kathryn L. Henderson, editors.

Description: Alexandria, VA : American Counseling Association, [2018] | Includes bibliographical references and index

Identifiers: LCCN 2018007027 | ISBN 9781556203282 (pbk. : alk. paper)

Classification: LCC RC466 | NLM WM 18 | DDC 362.2/04256 dc23 LC record available at https://lccn.loc.gov/2018007027

To mentors, who we often want to be when we become professionals, and the careers they model of integrity and compassion, who do the hard work with the students who need it the most

—KLH

To clinical faculty and supervisors, the frontline gatekeepers for our respective professions, for your courage and commitment to developing future ethical, effective clinical professionals and redirecting those who are unable to attain expected standards. Thank you for protecting the quality of the mental health community and those who seek our expertise to pursue their fullest potential.

—AMH

• • •

Preface

The term gatekeeper is a metaphor for those who monitor or oversee the progress of others while simultaneously controlling admission or access to an entity. In the context of career preparation programs, the gatekeeper is an experienced member of a profession who oversees the academic and clinical development of individuals preparing to enter the field while upholding professional standards for the welfare of future clients. Allowing qualified individuals to successfully progress through training and pass through “gates,” such as graduation and licensure, implies that those individuals have met minimal clinical training standards. Gatekeeping is the inherent responsibility of educators and supervisors in the mental health professions. Jurisdictional regulatory and licensing boards, accrediting bodies, and professional associations mandate gatekeeping in laws, rules, standards, and ethics codes. The health professions are increasingly being held accountable for developing standards and enacting practices that fulfill quality assurance expectations that protect the public and safeguard clients. The effects of gateslipping can be life threatening and/or result in long-term psychological injury. Passing unqualified students for graduation or endorsing incapable supervisees for licensure endangers the welfare of others. Ignoring gatekeeping mandates risks harming a trainee or other colleagues who may be affected by his or her actions, compromises the integrity of the clinical professions, and diminishes the trustworthiness and reputation of mental health training programs and related agencies. Gatekeeping is also a very challenging professional responsibility. The literatures in each of the allied professions—counseling, social

work, psychology, and marriage and family therapy—reflect the challenges of the gatekeeper's role.

The goal of this book is to support faculty and supervisors to engage effectively in the tasks and challenges of the gatekeeping process. The book has been written with the intention of bringing together the developing body of professional performance standards for trainees from multiple behavioral health fields. It is accompanied by suggested standards for best practices across the myriad gatekeeping tasks and processes. This book aims to be a guidebook for clinical faculty and supervisors that supports the development of gatekeeping practices and policies found in the current literature. This volume can also be useful in training new supervisors and doctoral students preparing to assume the role of gatekeeper. The philosophical foundations supporting gatekeeping are examined, along with suggestions for best practices and tools and templates that can be used with trainees.

A trainee's fitness in the domains of academic and clinical ability can be readily established through the use of evaluative measures that assess commonly held standards for performance. However, evaluating trainee competency in the domains of interpersonal behavior, intrapersonal functioning, and professional conduct to determine readiness to practice is much more subjective. This critical domain of trainee development—the heart of the gatekeeping focus —is less clearly defined and lacks common agreement within and across the mental health professions; thus, it is typically the area of greatest concern for clinical educators and supervisors.

Chapters in this book discuss the following topics addressing gatekeeping in terms of the professional conduct and personal behavior of students and supervisees.

Chapter 1 provides an introduction to gatekeeping by reviewing the foundational principles that guide gatekeeping practices. It begins the discussion of ethical principles and legal concepts pertinent to gatekeeping that are woven throughout the book as they pertain to various practices or stages of the process.

Chapter 2 defines the lexicon that is specifically relevant to the practice of gatekeeping, offering a compilation and background review of key terminology. Professional terminology is introduced that should be avoided, along with the background or history of the word usage and current recommended language for practice. General legal perspectives, such as due process and liability, are applied to the practice of gatekeeping, in addition to vocabulary and definitions found in other guiding documents in the clinical professions.

The challenge of addressing problematic trainees, a concern of every faculty member and supervisor, is the focus of Chapter 3. The author of this chapter proposes the development of policies, systems, and strategies for assisting students and supervisees who are exhibiting problematic behavior in their developmental process as clinical professionals.

Recognizing that training is a developmental process and that all trainees have unique personal identities, Chapter 4 encourages gatekeepers to be sensitive to and respectful of the broader contextual factors that may overlay trainee functioning. This chapter represents one of the inherent tensions in gatekeeping: upholding professional standards and the duty to protect future clients while simultaneously being sensitive to trainees' developmental processes and caring for their individual experiences and differences.

Chapter 5 offers descriptions of the roles and responsibilities faculty and supervisors have in gatekeeping activities as defined by professional standards. This chapter considers the various mandates for training practitioners, including licensure laws, accreditation standards, and codes of ethics from the mental health professions.

An important aspect of efficacious gatekeeping is garnering active support and participation from multiple constituencies. Chapter 6 describes the multiple institutional influences that interact to support or hinder the gatekeeping process. This chapter identifies potential stakeholders and suggests methods of collaboration essential to successful gatekeeping.

How does a clinical program or agency site inform students and supervisees about expectations for personal behavior and professional conduct? Chapter 7 identifies procedures for clearly advising prospective trainees about graduate program or agency expectations, standards, and gatekeeping policies at various points of contact, starting with admissions.

Chapter 8 reviews the literature from the mental health professions about trainee problems of professional competency. Empirical research on the personal behavior and professional conduct of trainees is reviewed in order to assist programs in constructing their own set of expectations and standards for trainee performance.

Once programs identify expectations or standards for trainee behavior, they must undertake the process of evaluating the meeting of those behavioral standards. Chapter 9 suggests methods for assessing and evaluating trainee conduct and behavior and offers a review of formal measures currently available in the field.

Chapter 10 describes best practices for intervening when trainees demonstrate problems with professional competency. In some situations, trainees may struggle with change, may be incapable of meeting required standards of behavior and conduct, or may be unwilling to comply with standards. A range of possible strategies and interventions is offered in this chapter, including formal remediation plans and accompanying remedial interventions.

Throughout the gatekeeping process, documentation is critical for legal and ethical reasons. Chapter 11 suggests best practice procedures in documenting, such as verifying that published procedures were followed, documenting subsequent actions taken, and verifying trainee actions and reactions. Examples of documentation formats are illustrated in this chapter.

Avoiding the need to engage in gatekeeping processes, the situation preferred by most professors and supervisors, can lie in prevention efforts. Chapter 12 offers strategies for preempting the development of problematic behavior in trainees and for curtailing problems through education, relationship building, and other early intervention approaches, including the admissions process.

The appendices offer a detailed review of ethics codes from several professions that directly address gatekeeping functions. Sample documentation and forms that may be adapted for use in practice are also included for readers of this book. These include sample correspondence and examples of evaluation and prevention strategies.

In sum, this book aims to be a practical resource to assist educators and supervisors in the practice of gatekeeping and to give doctoral students and future supervisors a foundational understanding of the gatekeeping process. As a fundamental responsibility of faculty and supervisors, gatekeeping represents an ethical imperative to address the struggles and challenges trainees may experience in their development, which could lead to harming clients. The ethical mandate speaks not only to protecting the clinical professions and the public from harm but also to providing trainees with transparent feedback regarding their competence and their likelihood of success as professional clinicians. During their time of struggle and challenge, effective feedback and remedial support from gatekeepers can offer trainees an opportunity, should they choose to accept it, to achieve success and develop into competent, ethical, and professionally effective clinicians.

About the Editors

Alicia M. Homrich, PhD, is a professor in the Graduate Studies in Counseling program (accredited by the Council for Accreditation of Counseling and Related Educational Programs) at Rollins College in Winter Park, Florida. She is a licensed psychologist and licensed marriage and family therapist in the State of Florida, a national certified counselor, and a qualified supervisor. Dr. Homrich has been researching, publishing, and presenting on the topic of gatekeeping for more than 15 years. Her goals for publishing this book are to encourage faculty and supervisors to support optimal clinical trainee development by engaging in gatekeeping processes during pre- and postgraduate training, to safeguard clients, and to uphold the practice standards of the clinical professions.

Kathryn L. Henderson, PhD, is an assistant professor in the Department of Counseling and Applied Behavioral Studies at the University of Saint Joseph (accredited by the Council for Accreditation of Counseling and Related Educational Programs) in West Hartford, Connecticut. Dr. Henderson is a licensed professional counselor in Texas and a national certified counselor. Dr. Henderson has researched, published, and presented on student remediation and gatekeeping for more than 8 years. She is an advocate of early intervention and transparency in the gatekeeping process and views counselor self-care and wellness as cornerstones of ethical practice.

• • •

About the Contributors

Kyle D. Baldwin, EdD, is the clinical practice and assessment coordinator and a clinical professor of counseling in the Graduate Studies in Counseling program (accredited by the Council for Accreditation of Counseling and Related Educational Programs) at Rollins College in Winter Park, Florida. She is a licensed mental health counselor, national certified counselor, master addictions counselor, certified clinical mental health counselor, clinical sexologist, and qualified supervisor. Dr. Baldwin's research interests include counselor wellness and counselor education and supervision.

Theresa A. Coogan, PhD, is a counselor educator and educational consultant in Raleigh, North Carolina. She is a licensed/certified school counselor in Massachusetts and New York, a national certified school counselor, and national certified counselor. Dr. Coogan has worked as a counselor educator and program director for school counselor training for 10 years. She recently started an educational consulting business serving kindergarten–Grade 12 and higher education clients providing professional and curriculum development as well as program evaluation, gatekeeping, and accreditation compliance.

Leigh D. DeLorenzi, PhD, is an assistant professor in the Graduate Studies in Counseling program (accredited by the Council for Accreditation of Counseling and Related Educational Programs) at Rollins College in Winter Park, Florida, and a licensed mental health counselor in the State of Florida. Dr. DeLorenzi began researching and writing on the professional, interpersonal, and intrapersonal conduct behaviors of helping professionals in 2013. She has developed and implemented gatekeeping-focused assessment

systems for graduate programs to streamline and simplify the gatekeeping process from preadmission to graduation.

Roxane L. Dufrene, PhD, is an associate professor in the Counselor Education Program at the University of New Orleans (accredited by the Council for Accreditation of Counseling and Related Educational Programs) in Louisiana. She is a licensed professional counselor and licensed marriage and family therapist in the State of Louisiana as well as a national certified counselor. Dr. Dufrene has been researching and presenting on the topic of remediation for more than 10 years.

Page L. Thanasiu, PhD, is an assistant professor of counselor education at Stetson University (accredited by the Council for Accreditation of Counseling and Related Educational Programs) in DeLand, Florida. She is a licensed mental health counselor and qualified supervisor in the State of Florida. At the national level, she is credentialed as a registered play therapist supervisor and a national certified counselor. Dr. Thanasiu has been supporting master's-level students through remediation and gatekeeping processes for the past 10 years and truly appreciates the opportunity to join trainees on their developmental journey.

Acknowledgments

A special thanks to Dr. Burt Bertram, who has been a longtime advocate and supporter for this project. Without his encouragement and professional mentorship, this book would not have been written.

We would also like to acknowledge the work of Michelle Sullivan, a graduate assistant at Rollins College, who offered invaluable support as an early copy editor and research assistant. A huge thank-you for your help with this project!

Chapter 1 Introduction to Gatekeeping

Alicia M. Homrich

The term gatekeeping is thought to have first originated in the arena of communications wherein an editor or editorial board determined which information or news stories would be pursued and which would be shelved (Kerl & Eichler, 2005). Gatekeeping was a point of control that advanced or deterred progression through the publication process. This activity is akin to the credentialing process, through which an individual prepares for and applies for entry into a profession, documenting satisfactory achievement of the requisite training in knowledge and skills and the professional qualities necessary to be recognized as a full practitioner. In all cases, approval of an individual to enter a profession is sanctioned by appointed senior practitioners with professional experience and the credentials to make such a determination. Within the context of the allied mental health professions, multiple scholars have defined the term gatekeeping as the ongoing responsibility of faculty members and clinical supervisors to monitor trainee progress and appropriateness to enter professional practice.

The Purposes of Gatekeeping

The two primary purposes of gatekeeping are to protect the integrity of the clinical professions and to prevent harm to clientele receiving services from incompetent clinicians (Brear, Dorrian, & Luscri, 2008). A secondary goal of gatekeeping is to consider the best interests of others, be it the trainee, the training community, the clinical or educational setting, or the population at large (Brear & Dorrian,

2010). Bodner (2012) noted that an additional responsibility of gatekeeping is to uphold professional standards, including the principles of beneficence, nonmaleficence, fidelity, personal dignity, and justice, as described in most ethics codes of the clinical professions.

The charge to the professions' gatekeepers is to enforce gatekeeping policies and procedures in order to reduce the incidence of advancing poorly or marginally suited trainees through graduate training and onto licensure in a clinical profession without intervention. This phenomenon was defined by Gaubatz and Vera (2002) as gateslipping. They found that clinical training programs that implemented formalized gatekeeping practices “reduce the number of deficient students who slip through programs' gates (i.e., graduate without remedial attention)” (p. 296). Thoughtful gatekeeping practices protect the public and the clinical professions from inept practitioners.

The Role of the Gatekeeper

Gatekeepers are the persons responsible for ethically monitoring trainees' progression through gatekeeping checkpoints prior to endorsing them for independent professional practice. In the clinical professions, educators and supervisors serve in this role both before and after trainees receive a degree. Gatekeeping is one responsibility expected of supervisors and/or faculty members who have oversight of trainees. Gatekeeping is an aspect of the assessment and evaluation processes incumbent on every supervisor and professor who has a role in preparing future clinicians. Gizara and Forrest (2004) described gatekeepers as quality control agents for the clinical training experience because they determine the readiness and fit of candidates for their particular profession. Gatekeepers institute evaluative procedures, deliver feedback aimed at improvement, provide trainees with the opportunity to respond to and address concerns, and take responsibility for deciding whether and when to permit trainees to continue to the next phase of the training process or to stop their progression for the purpose of remediating behaviors of concern

(Gaubatz & Vera, 2002; Ziomek-Daigle & Christensen, 2010).

Gatekeepers act to “ensure that those who graduate are capable of interacting with clients, colleagues, and the community in an ethical and competent manner” (J. Miller & Koerin, 2002, p. 1) and “control the access of impaired, unethical or incompetent counselors to clients, thereby protecting clients who are likely to be at a highly vulnerable stage of their lives” (Bhat, 2005, p. 399). The trainee's ability and/or willingness to achieve the requisite competencies of a given clinical profession predicts his or her progression through the various gatekeeping checkpoints across the training process (see Figure 1.1).

Figure 1.1 Gatekeeping Checkpoints

Use these points for evaluating personal behavior and professional conduct to determine continuation of clinical training.

Most educators and supervisors in clinical programs are energized by the prospect of training individuals to become competent, ethically practicing professionals. This enthusiasm and commitment applies to training programs across the behavioral health fields, including the professions of mental health counseling; marriage and family therapy; psychology; social work; and specialized practice fields such as school counseling, school psychology, rehabilitation counseling, or neuropsychology. Whether professors in academic programs, faculty supervising students in practicum or internship courses, field site clinicians engaged in supervisory experiences with graduate students, or supervisors of postdegree trainees obtaining experience in fulfillment of licensure requirements, clinical trainers have one thing in common: the opportunity to influence the

development of clinical knowledge, skills, and professionalism in novice members of the profession. In legal terms, this role is known as the respondeat superior (see On the Legal Side 1.1): the professional responsible for the actions of trainees (Wheeler & Bertram, 2015).

Inherent in the position of respondeat superior are multiple professional obligations. According to Saccuzzo (1997), these duties include monitoring the training and supervisory processes to:

1. protect the welfare of current and future clients (patients) from harm by ensuring that they receive effective treatment, that their rights are protected, and that they are treated with dignity and respect;

2. protect the welfare of the student or supervisee;

3. protect the well-being of other trainees or colleagues who may be affected by the individual student or supervisee;

4. protect the integrity of the clinical professions by graduating and endorsing for licensure only those practitioners who demonstrate the competencies necessary to be effective practitioners; and

5. protect the trustworthiness and reputation of the program, institution, or agency (although not a direct duty of respondeat superiors, this secondary influence is often the concern of administrators and other affiliates of the institution, such as alumni).

On the Legal Side 1.1

A Latin term, respondeat superior means “let the master answer or respond.” This legal doctrine holds that a person such as an employer or a supervisor is legally responsible for the wrongful acts of those over which he or she has charge, such as an employee or supervisee. Essentially, when the respondeat superior premise is invoked in a legal proceeding, a plaintiff will look to hold both the employer and the employee liable. There is no national standard for respondeat superiors. Because states create their own standards for the doctrine, different jurisdictions use different tests to prove the responsibility of the respondeat superior (Cornell Law School Legal Information Institute, 2017). Clinical supervisors of predegree and prelicensed counselors can be identified as respondeat superiors, which means that they can be held legally responsible for the actions of their supervisees (Saccuzzo, 1997; Wheeler & Bertram, 2015).

These responsibilities also converge to inform the direction of activities and procedures known as gatekeeping.

The Process of Gatekeeping

Clinical trainees are expected to progress through a series of gates or checkpoints, as illustrated in Figure 1.1, that are carefully placed across the training experience to substantiate attainment or demonstration of competencies in three domains: acquired knowledge, execution of clinical skill, and demonstration of personal behaviors or professional conduct appropriate for a practicing clinician. Fundamental to this process are the procedures of monitoring and evaluating trainee development to ascertain whether expected levels of performance have been achieved to support

continued advancement toward graduation, licensure, and eventual independent professional practice (Brear et al., 2008; Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2015). The process of gatekeeping also incorporates engagement in activities that support trainee development or remedy stalled progress. Gatekeeping may also involve stopping a trainee from graduating or gaining licensure in his or her chosen profession (Koerin & Miller, 1995) because of an inability or lack of willingness to meet standards or professional expectations. Multiple processes are involved in gatekeeping and are the topics featured in this book.

The Mandate for Gatekeeping

All clinical professions reference the obligation of preventing inept practitioners from entering into the profession primarily to protect clients from harm. This mandate is identified by multiple governing bodies within each professional group and extends to all members of the profession. In the realm of preprofessional preparation, the gatekeeping obligation is typically fulfilled by clinical faculty and supervisors serving as respondeat superiors accountable for overseeing the training process and trainees. The responsibilities of gatekeeping include monitoring, evaluating, and determining which trainees can appropriately enter the given profession while remediating or stopping those who cannot. Where and how this mandate is explained or defined across the clinical professions varies.

Professional Associations' Codes of Ethics

General expectations for gatekeeping are addressed in the ethics codes of the four primary clinical professions: the American Counseling Association (ACA), American Psychological Association (APA), National Association of Social Workers (NASW), and American Association for Marriage and Family Therapy (AAMFT).

Above all, professional ethics uphold the standards of beneficence and nonmaleficence: striving to do no harm and protect the rights and welfare of those with whom counselors and therapists interact,

especially clients. Standards in professional ethics also identify some criteria for professional demeanor and behavior for members of their respective organizations beyond the competencies of having the knowledge and skills to practice effectively. Most ethical standards delineate or infer that students and supervisees will adhere to the same ideals as professional members. Chapter 7 provides examples of these expectations.

The general tenets of ethics codes stipulate the role of the gatekeeper for members who are educators or supervisors; however, the amount of detail varies considerably across the four major mental health professions. For example, the APA Ethical Principles of Psychologists and Code of Conduct (APA, 2017c) states in Standard 7.04(2) that psychologists do not disclose personal information about trainees except when the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others.

Other APA standards address timely assessment and feedback processes; however, they do not specifically address the role or responsibility of respondeat superiors in training positions to protect clients or the profession from inappropriate trainees via the gatekeeping process. Bodner (2012) extrapolated the ethical principles that she believed apply to gatekeeping practices in psychology.

The NASW Code of Ethics (NASW, 2017) details the obligation of social workers to address their own impairment or the impaired, incompetent, or unethical conduct of colleagues—as do all clinical professions' ethics codes; however, the ethical standards are very vague in reference to trainees and include only that “social workers who function as educators or field instructors for students should evaluate students' performance in a manner that is fair and respectful” (Standard 3.02[b]). Descriptions of “fair and respectful” are undefined and left to the assumptions of the members.

The 2015 revision of AAMFT's Code of Ethics (AAMFT, 2015) reveals standards that are similarly ambiguous when describing the role and expectations of gatekeepers. Standard 4.4 reads: “Oversight of Supervisee Competence. Marriage and family therapists do not permit students or supervisees to perform or to hold themselves out as competent to perform professional services beyond their training, level of experience, and competence.” This standard is generally known as the scope of practice clause and is included in every ethics code as a principle that applies to all practicing professionals. Standard 4.5 reads: “Oversight of Supervisee Professionalism. Marriage and family therapists take reasonable measures to ensure that services provided by supervisees are professional.” This standard does not offer an explanation or definition of behaviors that qualify as “professional,” which could be interpreted broadly in a gatekeeping proceeding. The ACA Code of Ethics (ACA, 2014a) offers the most comprehensive ethical guidelines for supervisors and educators engaged in training by describing key components of the gatekeeping process, including monitoring, evaluating, protecting clients, and determining continuation in the profession. This code is unique in specifying that trainees are obligated to follow the ACA Code of Ethics and includes an entire section of standards that support gatekeepers by defining expectations for professional behavior:

Section F: Supervision, Training, and Teaching

F.1. Counselor Supervision and Client Welfare

F.1.a. Client Welfare A primary obligation of counseling supervisors is to monitor the services provided by supervisees. Counseling supervisors monitor client welfare and supervisee performance and professional development. To fulfill these obligations, supervisors meet regularly with supervisees to review the supervisees' work and help them become prepared to serve a range of diverse clients. Supervisees have a responsibility to understand and follow the ACA Code of Ethics.

F.4. Supervisor Responsibilities

F.4.a. Informed Consent for Supervision Supervisors are responsible for incorporating into their supervision the principles of informed consent and participation. Supervisors inform supervisees of the policies and procedures to which supervisors are to adhere and the mechanisms for due process appeal of individual supervisor actions. The issues unique to the use of distance supervision are to be included in the documentation as necessary.

F.5. Student and Supervisee Responsibilities

F.5.a. Ethical Responsibilities Students and supervisees have a responsibility to understand and follow the ACA Code of Ethics. Students and supervisees have the same obligation to clients as those required of professional counselors.

F.6. Counseling Supervision Evaluation, Remediation, and Endorsement

F.6.a. Evaluation Supervisors document and provide supervisees with ongoing feedback regarding their performance and schedule periodic formal evaluative sessions throughout the supervisory relationship.

F.6.b. Gatekeeping and Remediation Through initial and ongoing evaluation, supervisors are aware of supervisee limitations that might impede performance. Supervisors assist supervisees in securing remedial assistance when needed. They recommend dismissal from training programs, applied counseling settings, and state or voluntary professional credentialing processes when those supervisees are unable to demonstrate that they can provide competent professional services to a range of diverse clients. Supervisors seek consultation and document their decisions to dismiss or refer supervisees

for assistance. They ensure that supervisees are aware of options available to them to address such decisions.

F.8. Student Welfare

F.8.d. Addressing Personal Concerns Counselor educators may require students to address any personal concerns that have the potential to affect professional competency.

F.9. Evaluation and Remediation

F.9.a. Evaluation of Students Counselor educators clearly state to students, prior to and throughout the training program, the levels of competency expected, appraisal methods, and timing of evaluations for both didactic and clinical competencies. Counselor educators provide students with ongoing feedback regarding their performance throughout the training program.

F.9.b. Limitations Counselor educators, through ongoing evaluation, are aware of and address the inability of some students to achieve counseling competencies. Counselor educators do the following:

1. assist students in securing remedial assistance when needed,

2. seek professional consultation and document their decision to dismiss or refer students for assistance, and

3. ensure that students have recourse in a timely manner to address decisions requiring them to seek assistance or to dismiss them and provide students with due process according to institutional policies and procedures. (pp. 12–15)

The ACA Code of Ethics is much more specific and helpful in providing guidance to faculty and supervisors than most codes across the clinical professions, as illustrated above. Appendix A provides excerpts from ethics codes that guide gatekeeping

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