Key factors and trends in health care will have an impact on the ethical practice of counselors. Ethical challenges to clinical practice presented by trends in managed care are discussed in relation to the American Counseling Association (1995) Code of Ethics and Standards of Practice. Recommendations for practice are also included.
In the past two decades, counselors have made sigruficant strides toward establishing counseling as a separate and legtimate profession, dfferent from other related drsciphes, such as clinical social work, c h c a l and counseling psychology, psychiatric nursing, and psychiatry. Professionalization activities have included gaining licensure in 45 states and the District of Columbia, acheving privileged communication for interactions between counselors and clients (Glosoff, Herlihy, & Spence, in press), and acheving societal recognition of counsehg as an important component of mental health services (Sweeney, 1995). At the same time, signhcant changes have been occurring in the health care delivery system in the United States. In particular, the advent of managed care has affected, and wdl continue to affect, the work of professional counselors. With the increasing professionalization of counselmg, counselors w d be held to higher standards of practice, and they wdl be expected to uphold these standards in a changmg practice environment. We believe that these forces will also necessitate changes in how counselors define ethical practice.
A look into the future almost certamly includes a continued departure from fee-for-service models of physical and mental health care and a move toward managed care systems (Hoyt, 1995; Stern, 1993). These systems,