Counseling in hospitals

Standards for Hospital Counseling

Standards for Counselling are based on the following principles:

1. Competence.
2. Confidentiality.
3. Responsibility.
4. Accountability.

The purpose of these standards is to provide the counsellor with a framework within which to work in accordance with the code of professional ethics. Within the hospital setting these standards of counselling should be applied in the following ways:


The counsellor must be aware of the expectations, needs and concerns of the type of client he/she is working with, e.g. AIDS patients, the bereaved, adolescents, the terminally ill etc. The counsellor must also have accurate and up to date information on issues affecting these clients, e.g. end-of-life issues in the case of the terminally ill.

The counsellor must be well trained and qualified to do his job – he should have completed a basic course in counselling training and should systematically seek avenues for enhancing his professional competence, skills and self awareness. The counsellor must  know the limits to competence and seek appropriate help wherever needed, through referral or supervision.


The counsellor must never reveal information about the client to anyone without securing his/her consent, except when there is intention to commit suicide/crime or cause serious harm to another person. The client should be made aware that the counsellor will not keep confidential any information that will harm him/her or another person. When it is deemed necessary for the counsellor to break confidentiality (for the betterment of the client) he should use his discretion as to what and how much to reveal, and to whom.

The counselling environment should facilitate and ensure confidentiality of the counselling process; the room set aside for counselling should be well ventilated, calm and offer privacy, and also be clean, adequately furnished with a secure place where records can be stored and locked. The counsellor must also devise a recording system that does not violate confidentiality, e.g. using a code number on files instead of clients’ names.


The counsellor must uphold professional ethics at every stage of the counselling process;
recognize the value and dignity of clients irrespective of status, age, race, sexual orientation, beliefs, etc.

The counsellor must maintain a professional relationship with the client. If the counselling relationship becomes emotionally unmanageable or otherwise difficult to handle, he should immediately refer the client and seek advice from his supervisor; he must promote and facilitate the self development of clients, be dependable, reliable and faithful, and be committed, attentive and resourceful in meeting the needs of his clients in the hospital setting. The counsellor must also be mindful of his position as a representative of the hospital, be a part of the system and be true to the vision of the hospital.


The counsellor is accountable to his client and should facilitate growth and change without causing detriment to the client and undermining his or her individuality; the counsellor should encourage clients to improve their life skills while respecting their uniqueness as individuals.

The counsellor is also accountable to stakeholders like the hospital administration, sponsors, etc. A major issue in accountability is showing “results”, or the counsellor’s work being linked to outcome. This can be very complex, as often the desired outcome of counselling may occur outside the location where counselling is done, may differ from one client to another, or may happen without the client even being aware of it (e.g. subtle attitudinal or behavioral changes). It may also involve a sequence of steps where it may not be easy to show progress toward the long term goals of the counselling process. So it becomes important to develop a complete program evaluation plan by experts familiar with both counselling theory and program evaluation.

Documentation of the counsellor’s work is an important aspect of maintaining accountability. The counsellor should show not only that he can provide services that meet both professional standards and the requirements of the counselling program, but should offer evidence that he is actually providing such services.

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