Ethics in private practice should not feel like a group project built on rumors.

And yet… here we are.

If you’ve spent any time in professional groups, you’ve probably seen it:

• Someone asks an ethics question

• Ten people respond

• Half the answers contradict each other

Some responses are based on actual ethical guidance. Others are based on preferences or things people have “heard before.” Yes, ethics requires judgment, but it is not based on opinions - it is based on professional responsibility.

What Ethics Actually Does (and Doesn’t Do)

Ethics is not just “don’t do bad stuff.” The ethics we abide by provide a framework for professional decision-making.

It helps you:

• Protect clients

• Protect yourself

• Maintain professional integrity

• Build public trust

The hard part is that ethical guidelines do not come with a script for every situation.

The Patterns Behind Most Ethics Questions

In private practice, ethical issues tend to cluster in the same areas over and over again.

Clinical & Client Care

• Confidentiality

• Informed consent

• Competence

• Continuity of care

Business & Practice Operations

• Billing and documentation

• Advertising and representation

• Conflicts of interest

• Supervision and delegation

This is where much of the real-world pressure shows up and where gray areas live.

Where Ethics Gets Messy: Real-World Examples

Some ethical violations aren’t obvious.

Confidentiality

A parent asks you to send notes to a teacher. You’ve communicated before, so it feels routine.

But there’s no current authorization.

This isn’t dramatic, but it’s still a breach. 

Informed Consent

A caregiver signs intake paperwork, but later says they didn’t realize what therapy would involve.

You got the signature. But did they actually understand?

Competence

You get a referral outside your typical population. There’s a long waitlist elsewhere. The family is motivated.

You could take the case. But should you?

Continuity of Care

A client has missed multiple sessions. You’re frustrated and considering immediate discharge.

The discharge itself may be justified. How you handle it is the ethical issue.

Billing & Documentation

A clinic pushes clinicians to bill an additional code whenever part of an exam is completed, even if it may already be included.

Billing pressure + productivity expectations + “this is how we do it here” = ethical violation.

Advertising & Representation

Your website says you “get fast results” and lists specialties based on general experience.

It sounds good, but getting “fast results” has red flags all over it.

Conflicts of Interest

You work in a school and also own a private practice. Families ask where to get additional services.

You could mention your practice. But now your recommendation is tied to your financial interest.

Supervision & Delegation

You’re busy. An assistant “knows the routine,” so you start having them explain programs or answer clinical questions.

It’s efficient, but is it within their scope?

A Better Way to Think Through Ethics

Instead of asking:

“Is this allowed?”

Try asking:

• What is in the client’s best interest?

• What am I being asked to do?

• What am I representing, documenting, or delegating?

• Would I be comfortable explaining this decision clearly?

These questions matter more than memorizing rules.

The Bottom Line

Ethics in private practice shows up in everyday decisions, lives in gray areas (not all are obvious violations), and requires judgment, not just rule memorization.

And whether we like it or not, it’s tied to:

• Money

• Time

• Pressure

• Systems

• and sometimes, conflicting priorities

Next steps

Join the free Private Practice Open Access community space (updates, free events, discussion).

Resources

American Speech-Language-Hearing Association. (2023). Code of ethics. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (n.d.). Issues in ethics: Obtaining clients for private practice from primary place of employment. https://www.asha.org/practice/ethics/obtaining-clients-for-private-practice-from-primary-place-of-employment/

American Speech-Language-Hearing Association. (n.d.). Issues in ethics: Confidentiality. https://www.asha.org/practice/ethics/confidentiality/

American Speech-Language-Hearing Association. (n.d.). Issues in ethics: Client abandonment. https://www.asha.org/practice/ethics/client-abandonment/

American Speech-Language-Hearing Association. (n.d.). Issues in ethics: Competition in professional practice. https://www.asha.org/practice/ethics/competition-in-professional-practice/

Shah, P., & Thornton, I. (2023). Informed consent. In StatPearls. StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK430827/