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May 13, 2019

Ethics and Complementary and Alternative Modalities

Complementary and alternative modalities (CAM) are health approaches that often combine treatments from Western and Eastern cultures. Examples of CAM approaches include yoga, meditation, mindfulness, acupuncture, Reiki, nutrition, and Emotional Freedom Techniques (EFT), among many others. Increasing numbers of clients have become interested in and are using CAM to address mental health issues and because of this change, it would benefit counselors to better understand CAM modalities, existing research to support the use of CAM to treat mental health, and ethical concerns to consider when doing so. Please note that this blog contains initial observations that are not exhaustive and not intended to equate to legal guidance or definitive ethical guidelines.

There are some CAM modalities that counselors can, and have, already integrated into their practices. Many of these approaches are the more mainstream or well-researched practices such as guided imagery, diaphragmatic breathing, mindfulness-based therapies, and various types of meditation. These approaches have been fairly heavily researched for the past twenty years and most counselors are confident and well-versed in utilizing them once they receive some education and training. However, recent research has emphasized that even within these accepted approaches, we need to continue to increase our awareness of trauma-informed treatment, meaning that there are some meditation practices that can increase traumatic feelings as opposed to decreasing arousal. In addition, there are some CAM practices that are less heavily researched.

Currently, there are no established competencies for the ethics of CAM in counseling, however there are three initial guidelines for counselors to consider regarding the ethical issues of CAM. Most CAM practices fall under approaches that counselors can fairly safely integrate into their practices, CAM modalities that should only be engaged in a team treatment model, and then common errors counselors make when integrating CAM with counseling.

Some CAM approaches such as EFT and mindfulness-based practices can be directly integrated into your counseling practices. EFT is a self-acupressure technique that clients can use in sessions or on their own. Current research has shown that EFT seems to reduce symptoms of trauma, anxiety, depression, and with some behavioral or process disorders such as binge eating disorder. Counselors can obtain EFT training and certification and then offer EFT as a powerful tool to enhance the healing process and that is empowering to clients because they can use it when they are triggered in between sessions. The much more common mindfulness-based modalities have abundant research behind them and strong and varied training and certification programs and as a result, many counselors have begun to incorporate them into their practices. Direct integration of CAM modalities is more limited but can be done if counselors seek proper training and oversight.

For most CAM approaches in general it’s best to work in a team treatment approach. This is the safest method because each practitioner operates within his/her own certifications and licenses. An example would be a client who struggles with anxiety and depression. The mental health counselor would continue to provide evidence-based talk therapy but might also refer the client to a nutritionist who specializes in gut health which can assist with depression treatment and an acupuncturist who can assist with symptoms of anxiety. Each practitioner is trained, certified, and skilled within their own wheelhouses which protects both the client and each practitioner. This model is fairly straightforward because it follows a common referral model. Our one suggestion is that if you are interested in participating in this holistic behavioral health model, we recommend personally getting to know the CAM practitioners in your community as CAM practitioner quality can vary and it’s best to find the strongest and most ethical CAM practitioners for your clients.

We have worked with Midge Murphy, an attorney who specializes in helping mental health professionals who are interested in integrating energy therapy such as EFT with their practices, and she emphasizes ongoing self-accountability, attorney consultation, certification, and proper documentation and representation. Creating accountability structures through ongoing supervision from leaders in your CAM modality and meeting in peer-supervision groups are important. One issue that often emerges is that people “fall in love” with their chosen CAM approach and sometimes unwittingly coerce clients into using them or passively might make them feel badly if they refrain from trying them. It is extremely important to continually monitor this possible internal dynamic and be sure that you communicate to your clients that you have many other clinical tools to offer if they are uncomfortable with any CAM treatment.

When initially considering integrating a CAM modality with your practice, it is critical to consult with an attorney as you create your paperwork. Because integrating some of the less mainstream approaches increases risk in your practice, it is advised that you consult with an attorney who can assist with your documentation and even advise your marketing materials.

One of the strongest ways to practice at the highest ethical standard is to seek out and complete certification in your CAM approach as it indicates that you have obtained proper and supervised instruction in your CAM approach. If an issue comes up, then you have documentation supporting your skillful use of the CAM approach.

As more clients and counselors become interested in CAM approaches to add to their wellness repertoires, new ethical issues are likely to arise. Staying abreast of the evidence-base, remaining plugged in to accountability structures, and careful and intentional documentation will assist the highest ethical standards in this emerging area.
Dr. Christine Berger is an assistant professor of counseling and is licensed as a professional counselor in Maryland and Virginia. She received her Ph.D. in Counselor Education and Supervision from Loyola University Maryland in 2009. Her research interests focus on the mental health applications of complementary and integrative therapies such as Emotional Freedom Techniques, energy healing, yoga, meditation, and mindfulness and she has published nationally on these topics. She is also a member of the executive board of the American Counseling Association division, the Association of Creativity in Counseling, and has been the Secretary of the Virginia Association of Counselor Education and Supervision. As a joint endeavor with Old Dominion University and the Integrative Therapies Institute, she offers training in complementary and integrative therapies to licensed professional counselors.

Suzan K. Thompson, Ph.D. is a licensed professional counselor in Virginia with over 30 years’ experience. She helps adults learn practical tools and strategies to manage anxiety, depression and trauma. Dr. Thompson also offers training in supervision as well as complementary and integrative therapies to professional counselors. Please visit:

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