514 - DEENA'S VERSION Ethics Flashcards
SAD Persons
WHAT: Assessment too to assess suicide risk/suicidality
- includes risk factors associated with suicide
S = sex
A = age
D = depression yes/no
P = previous attempt
E = ethanol (alc)
R = rational thinking loss
S = social support lacking
O = organized plan
N = no partner
S = sickness (physical)
Scoring: each risk factor is one point
0-2 –> no real problem
3-6 –> send home but check on frequently
5-6 –> consider hospitalization
7-10 –> hospitalization (voluntary or involuntary)
WHY: It’s import to be aware of the signs of and risk factors for suicide. This model does not consider other variables, but is a good tool to guide assessment, and should be used in addition to clinical judgment.
WHY: This model does not consider a variety of personal variables, but it is a very good model to base your assessment on. This should be used in combination with clinical judgment.
EXAMPLE: A client of yours mentions a history of suicidal thoughts. The client is a 24 year old woman, is diagnosed with depression, and does not have a significant other, few close friends friends, or family near by. According to SAD PERSONS she scores a 5, so you send her home but make check in texts or calls once a day until her next appointment.
assent vs consent to treatment
WHAT: Permission given by a person to receive psychological or medical treatment
Consent = given by 18+
Assent = given by child <18 OR someone mentally incapable of consent, ensure they understand therapy process and are willing to participant
must get consent from parent/guardian still
WHY: Important to know if you need to obtain assent or consent from a client, and what factors may prevent consent. It ensures clients are informed about the treatment process. Assent can be helpful if a child is being made to go to therapy.
EXAMPLE: A mother brings her 14 year old son to therapy. Prior to the first visit, the therapist obtains consent from the mother. Once the therapist and son meet, the therapist obtains assent from him– ensuring he’s willing to participate in treatment.
bartering of clinical services
WHAT: Exchanging therapy for goods or services from the client
- frowned upon– can be a boundary violation/crossing
If done, terms of the exchange should be clearly stated on paper and agreed upon
WHY: Important so a therapist knows bartering can be a boundary crossing, and can explain to a client why it is unethical for them to barter for therapy. Bartering can be done if there is no risk of exploitation or harm to client.
EXAMPLE: A client is unable to afford therapy anymore. The client offers weekly lawn care in exchange for weekly sessions. An agreement was drawn up that clearly outlined what was expected from both parties.
basic purpose of ethical practice
WHAT: Purpose is to protect the clients’ and the public’s well-being.
Guiding principles of ethical practice (ABNJVF)
- autonomy (respect clients’ right to make their own decisions)
- beneficence (try to only do good)
- nonmaleficence (not harm on purpose)
- justice (treating all clients fairly and equally)
- veracity (be truthful about tx process and outcome)
- fidelity (commitment to confidentiality, consistent support, acting in clients’ best interest, etc.)
WHY: Important as keeping these principles in mind help to ensure each client is receiving ethical, trustworthy, and equitable therapy. It also helps to guide judgement for situations such as when to break confidentiality.
EXAMPLE: A therapist has a heavy caseload and has been quite stressed. They receive a client with severe depression and suicide risk. The therapist knows they are already spread too thin and won’t be able to give the client the care they need, which may lead to harm to the client, so they refer them to another therapist.
confidentiality
WHAT: The obligation to keep all things discussed in a session private.
There are certain exceptions, which must be explained to and agreed upon by client:
- risk of harm to self of others
- suspected abuse to a vulnerable population (minors, elders, disabled persons)
- court ordered subpoena
WHY: It is extremely important to know when you can and cannot break confidentially. If confidentiality is broken when it should not have been, a therapist may face repercussions and the therapeutic alliance could be irreparably damaged. If one of the above issues are not reported, the therapist could again face repercussions, and it may result in harm to others.
EXAMPLE: A 13 year old child is in therapy, and reveals to the therapist that their father gets drunk and becomes abusive. The therapist is legally mandated to report this to the authorities. In this case, confidentiality should be broken.
confidentiality in group or marital counseling
WHAT: Way different than individual treatment.
Group = therapist must maintain confidentiality, but no guarantee other members of group will
Marriage = therapist must maintain confidentiality, needs to explain there cannot be any secrets from one spouse told to the therapist as they are not seen as 2 individual clients
WHY: It is important to be transparent in these situations and ensure all parties are aware of the expectations of confidentially. A misunderstanding could harm the therapeutic alliance.
EXAMPLE: A couple comes in for marriage counseling. During the session, the therapist explains why there cannot be any secrets. Even so, the husband tells the therapist after his wife leaves the room that he’s been having an affair with no intention to stop. The therapist says he has to tell his wife, as she is now required to share that information with her.
counseling competency
WHAT: An ability to perform tasks within the profession.
Includes…
- having the necessary knowledge and skills
- being emotionally competent
- practicing within their scope
- staying up to date with practice (done via continuing education credits)
WHY: Important for a therapist to ensure they striving to achieve all aspects of competence, as to provide the best possible tx and cause no harm.
EXAMPLE: A therapist receives a new client with borderline personality disorder. Because the therapist has only been trained in CBT and knows this client would need DBT, they decide to refer the client to another therapist. Treating the client would be practicing out of their scope and would not be of benefit to the patient.
direct liability
WHAT: A counselor is liable/legally responsible for their actions during therapy.
- violating confidentiality
- causing harm to client
- not following professional guidelines.
WHY: This is important is it requires therapists/license holders to be accountable to their actions.
EXAMPLE: A therapist was caught discussing details and personal information of a client. They are directly liable for their breech in confidentiality and responsible for harm to the patient from this. They will likely face legal consequences.
dual/multiple relationships
WHAT: Occur when multiple roles exist between a therapist and client. Considered boundary crossing
Includes…
- the therapist is in another relationship with client (client is their hairdresser or student)
- therapist is in a relationship with a person close to the client (dating the client’s sister)
- therapist is promising a future relationship (platonic, romantic, business, etc.)
WHY: Important as have multiple relationships can create a power imbalance in therapy, disrupt the therapeutic alliance, and affect the objectivity of the therapist. Best to avoid them entirely.
EXAMPLE: A therapist teaches on the side in a graduate program. A student comes to them one day seeking therapy. The therapist/professor says they cannot do that, as it is unethical and would be considered a dual relationship.
duty to warn/protect
WHAT: Therapist’s responsibility to warn authorities if client is at risk for hurting themselves.
AND
Therapist’s responsibility to inform a person if a client is at risk to harm said person
- client must have expressed intent directly towards an identifiable person
- TARASOFF CASE! just warning authorities not enough, must warn intended victim
WHY: Important as this is a situation in which the therapist is required to break confidentiality. If the therapist fails to warn and/or protect they may face repercussions.
EXAMPLE: A client calls their therapist one evening and says they want to say goodbye because they’ve decided to end their life. The therapist is legally (and morally) obligated to warn authorities and send an ambulance to the client’s home so they can be admitted.
ethics
WHAT: The standards that govern the conducts of professional members of a group/association –including therapists!
- the American Counseling Association and the American Psychological Associate have a handbook of ethical codes that must be followed by all practitioners
WHY: Ethical standards must be prioritized, even if they conflict with morals, values, or the law. Important to know that ethics are generally held above what the law says.
EXAMPLE: The APA code of ethics says therapists must wait 2 years after stopping treatment to have a sexual relationship with clients. Even though the therapist and client are legally of age to have a sexual relationship, if the therapist did not obey the code of ethics there would be repercussions.
ethical boundaries in clinical practice
WHAT: Boundaries that place limits on the therapist-client relationship
- involve physical boundaries or topics that are off limits
Boundary crossing = deviation from standard practice, may or may not be harmful, could be beneficial (ex: therapist hugging client after hard session) — use clinical judgement!!
Boundary violation = serious violation of ethical standards, causes harm to client (ex: having sex with client)
WHY: Important to remember a therapist must adhere to ethical codes regarding boundaries, but can use clinical judgement regarding boundary crossings.
Respecting boundaries are done to protect the therapeutic relationship and the client’s well-being.
EXAMPLE: A therapist is deciding if they should hug a very upset client following a hard session. The therapist considers the client’s culture, their comfort level surrounding physical touch, professional guidelines, and nature of their therapeutic relationship. The therapist uses their clinical judgment to decide this boundary crossing is fine as it will benefit and comfort the client.
ethnic-sensitive practice
WHAT: An approach that considers how the culture of a client may affect their behavior, attitudes, beliefs, symptom presentation, and response to treatment.
- ethical obligation
- leads to better therapeutic outcomes and stronger alliance
WHY: Important for counselors to be multiculturally competent and aware. They should take care to not apply their own biases to a client, and work to understand their client win the context of their culture.
EXAMPLE: A white therapist is seeing an Asian American client that values her parents opinions of her choices. he therapist will not be dismissive of the client’s concerns. Using an ethnic-sensitive approach, the therapist should recognize the parents’ concerns are influenced by Asian cultural norms and expectations.
HIPAA compliance
WHAT: Health Insurance Portability and Accountability Act
- requires the security and privacy of certain personal health information of clients receiving treatment
- psychotherapy notes protected under HIPAA meaning they must be adequately secured
WHY: Very important that a therapist adheres to the HIPAA privacy and security rules. Not only to protect their clients, but also to protect themselves from the repercussions of violating HIPAA.
EXAMPLE: A therapist is sitting in a public coffee shop reviewing her psychotherapy notes. This is a HIPAA violation, as the notes are required to be kept confidential, and someone in the coffee shop could read them.
legal aspects of informed consent
WHAT: The therapist must discuss…
- limits of confidentiality
- the nature of therapy
- goals or benefits
- risks
- duration and frequency
- payment/fees
In order to give consent, a person must…
- have the capacity to make rational decisions
- comprehend the information (mentally, speak the language, etc.)
- voluntarily decided, free from coercion
WHY: It is legally and ethically required for a client to give informed consent to treatment. The client must understand the process and possible outcomes of therapy.
EXAMPLE: During an intake session, a therapist goes over the informed consent with a client. They discuss limits of confidentiality, cost, and fees for not showing up to a session. The therapist explains the process of CBT and goals of this therapy. The client is now fully informed and can consent to begin treatment.
