The Ethical Implication of Bartering for Mental Health Services: Examining Interdisciplinary Ethical Standards.

Across disciplines, helping professionals are charged with offering services, without discrimination, to a diverse client base with respect to gender, sexual orientation, religious beliefs, cultural background, and socioeconomic status (American Counseling Association, 2005; American Psychological Association, 2002; Clinical Social Work Federation, 1997; National Association of Social Workers, 1996). This obligation leads some professionals, in an effort to serve as many clients as possible, to agree to enter into unorthodox bartering agreements with some clients who either cannot afford the professional's fees or whose cultural background emphasizes the use of barter transactions (Thomas, 2002; Zur, 2008). With the exception of the Psychology profession (American Psychological Association, 2002), the ethical standards of the various helping professions discourage the practice of bartering because of the resulting dual relationship it creates between practitioner and client (American Counseling Association, 2005; Clinical Social Work Federation, 1997; National Association of Social Workers, 1996). These standards, however, also offer guidelines to determine when such an arrangement might be appropriate. Literature on the subject of bartering is both scarce and polarized, as most seem to think the practice either is ill advised and should be entirely avoided (Canter, Bennett, Jones, & Nagy, 1994; Gutheil & Gabbard, 1993; Woody, 1998), or has therapeutic potential that, when used sparingly, outweighs the risks (Croxton, Jayaratne, & Mattison, 2002; Hendricks, 1979; Hill, 2000; Syme, 2006; Thomas, 2002; Zur, 2008). Given the emphases on multiculturalism and social justice within the counseling profession, counselors would benefit from a discussion outlining the benefits and risks associated with the practice of accepting barters for services. Toward this end, the proceeding discussion reviews the ethical codes of several helping professions as they pertain to the practice of bartering, and examines relevant literature. The purpose of this article is not to advocate for or against the practice of bartering, but rather to review current bartering practices in the literature and provide professionals with information needed to make informed decisions concerning the incorporation of bartering into their scopes of practices. Glossary of Terms There are several constructs in the proceeding discussion warranting definition. In the context of this paper, "bartering" is used to describe the use of goods and/or services as payment for mental health services. The term "mental health services" is used to describe a service such as personal counseling, career counseling, psychotherapy, psychiatric evaluation, social work, or any other service used to improve cognitive, emotional, or relational functioning. The use of the terms "therapy" and "psychotherapy" are meant to describe the practice of any of the aforementioned disciplines, while the term "therapist" refers to any professional practicing psychotherapy. Comparing Multidisciplinary Ethical Codes Bartering is a topic discussed in each of the respective ethical codes of the American Counseling Association (ACA; 2005), the American Psychological Association (APA; 2002), and National Association of Social Workers (NASW; 2008). These associations differ in the strength of the language of bartering guidelines from more restrictive (NASW) to more permissive (APA). The ACA's (2005) stance is that: Counselors may barter only if the relationship is not exploitive or harmful and does not place the counselor in an unfair advantage, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract. …