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.
licensure vs certification
WHAT:
Licensure =
- legally mandatory to practice
- obtained after education, training, and supervised practice
- given by a government controlled board
Certification =
- voluntary
- process of acquiring knowledge/skills
- given by professional organization/association
WHY: Important to remember a license can be revoked due to malpractice. It holds them accountable for their behavior.
EXAMPLE: As a licensed professional counselor, Dami has completed a master’s program with practicum and internship hours, and passed the states licensing exam. She decided she wants to primarily practice CBT, so she has began taking courses to become certified in it.
malpractice
WHAT: The failure of a counselor to provide the expected standard of care during treatment
- leads to direct harm to client
4 D’s needed for a successful malpractice case =
1) Duty - duty to provide care for and protect client
2) Deviate - therapist deviated from protocols/guidelines
3) Damages - the therapist harmed the client
4) Direct - prove that harm caused to client was a direct result of the therapist’s actions
WHY: Important to be aware that malpractice can lead legal action by the affected party. Being aware of the 4 D’s allows for the therapist to minimize risk of legal liability.
EXAMPLE: A client is suing a former male therapist she had after he began to make inappropriate sexual remarks and advances towards her. The therapist’s behavior caused her great emotional distress, and he was later found guilty of malpractice.
morality
WHAT: A person’s internal value system for what is wright and wrong + what is appropriate conduct
WHY: Important for a therapist to be aware of their morals, and be careful as to not impose their beliefs on their client. The therapist should always remain neutral and nonjudgemental.
EXAMPLE: A therapist is seeing a client that is struggling with substance abuse. Although the therapist believes using drugs is morally wrong, he does not judge the client or try to convince them of this. The therapist is supportive and empathic towards the client.
peer consultation
WHAT: Seeking guidance and expertise from professional peers
- confidentiality is still maintained
- should always document advice given
Beneficial because…
* reduces professional isolation
* exposes you to new ideas/perspectives
* provides opportunity for growth (in the form of feedback, guidance, new recognition of biases)
WHY: Peer consultation is very important for ethical practice and while using a risk management model. It allows a therapist to know if their biases are influencing a decisions and compare perspectives with others.
EXAMPLE: A therapist is seeing a client that seems to meet the criteria for borderline personality disorder. The therapist is certified to treat BPD, but is yet to use the skills in real life. The therapist decides to consult with her peer group to see if any of them have treated BPD, and to seek guidance and feedback during the process.
power dynamics
WHAT: Natural difference/contrast in power between therapist and client
- both have power, but in different ways
WHY: Important to be aware of the power dynamic in a session. Following ethical practicing guidelines ensures that clients are not harmed or exploited through the power difference.
EXAMPLE: In session, the therapist is always aware of the power dynamic between themselves and the client. To lessen the effects of this incongruent relationship, the therapist is always warm, empathetic, and genuine. They also explain processes and reasons behind the techniques/treatments, so the client feels less in the dark.
privileged communication
WHAT: Legal right of client and therapist that protects the confidentiality of in-session communication
- exceptions to confidentiality still apply tho
WHY: This is important as it offers protection for the client and therapist. It provides a client with the assurance that they are safe to share things in session. It gives a client the power to choose if they want their confidential communications to be shared or not.
EXAMPLE: A client tells their therapist they regularly smoke weed and have some stored at their house. Even though weed is illegal in their state, this information is considered privileged communication and protected by law.
pro bono service
WHAT: Service that therapist provides for free
- typically targeted towards people who lack money or other resources to get mental health care
WHY: Important as this service is very beneficial to the community since many people face barriers to accessing mental health care. Therapists are high encouraged to do pro bono services (sometimes required by ethical mandates).
EXAMPLE: A client came to an intake session, and upon learning the price of sessions, realized they would not be able to afford it. The therapist offered to provide the client with 10 pro bono sessions.
mens rea
WHAT: A legal phrase meaning guilty mind or guilty intent or criminal intent
- for someone to be convicted of a crime, persecution must prove the person engaged in the guilty act with guilty intent (mens rea)
- can be a deliberant or recklessness/negligence
Did they intent to commit the crime OR did the crime happen as a consequence of a behavior that was intended to be harmless?
WHY: It is important when deciding if someone is fit to stand trial. Psychologists can be called to give their opinion about a person’s state of mind or intent at the time a crime was committed.
EXAMPLE: A psychologist was called as an expert witness to discuss the mens rea of a group of teenagers that were charged with a crime. The teens had been bullying another boy, the boy killed themselves, and now the group is being charged with manslaughter. The psychologist is asked to determine if it was the group’s intent (when bullying) to cause the boy to kill himself?
professionalism
WHAT: A professional manner to present yourself
Includes…
- appropriate clothing
- respectful language
- proper behavior when interacting with a client + others
You can be unprofessional while still being ethical, however that’s not common.
WHY: This is important to preserve the integrity of the therapeutic alliance. It’s also important to be respectful of your coworkers and what people expect out of a workplace.
EXAMPLE: A therapist is frequently late to sessions, and often comes to work looking sloppy and disheveled. Not only is this disrespectful to the client, but it creates a strain on the therapeutic alliance.
reporting child abuse
WHAT: Licensed therapists are mandated reporters, meaning they’re legally required to report any suspected cases of child abuse shared in session to the authorities (Department of Social Services + the police) with 24 hours
- this is an exception to confidentiality and should to explained to client during informed consent process
WHY: Important as counselors who do not report suspected instances of child abuse will face legal and professional repercussions. The reason for suspicion and subsequent report must be documented.
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 police and DSS. In this case, confidentiality should be broken.
self-monitoring of ethical practice
WHAT: Counselors should self-monitor to ensure they are practicing within ethical codes + make sure they are emotionally competent to practice
- used in combination with peer consultation
WHY: Important for counselors to be aware of what is inside and outside of their scope. Practicing unethically will likely cause harm to patients. Also important to know that solely using self-monitoring may result in justification for ethical behaviors
EXAMPLE: A therapist accepts a small gift offered by a client. Later, she reflects about her decision and if it was ethical. Since she only used self-monitoring when accepting the gift, she consults with a peer to see if it was ethical behavior.
sexual intimacies with former clients
WHAT: Don’t ! Sexual relationships with current clients are NOT allowed.
Sexual relationships with former clients are allowed after 5-7 years, depending on the ACA or APA
- cannot promise a sexual relationship in the future either
WHY: Having a sexual relationship with a client is widely unethical and illegal, and is an abuse of the therapist’s power. Important to be careful to act within codes if considering a sexual relationship with a former client. Most ethical to not ever have one.
EXAMPLE: A therapist runs into a former client at the grocery store. The two haven’t seen each other in 8 years, and the therapist finds herself attracted to him. Even though technically enough time has passed to permit a sexual relationship, the therapist decides to keep the relationship professional.
Tarasoff case
WHAT: A legal case that established a clinician’s duty to protect/warn third parties.
- a therapist is legally required to notify authorities + third part if a client says they are going to harm a clearly identifiable person/group
Case - a psychologist was treating a patient that threatened to kill a specific person. psychologist let the patient go, patient killed the person, therapist was help partially responsible
WHY: Important for therapist to remember they must breach confidentiality if a client has threatened violence. Not doing so will likely result in legal and professional consequences.
EXAMPLE: A therapist is treating a male client for his borderline personality disorder. He says he just found out his girlfriend is cheating on him and he’s so angry he’s going to stab her when he’s home tonight. Due to the precedent set by the Tarasoff case, the therapist has a duty to notify the authorities and the girlfriend of the client’s threat.
treatment of minors
WHAT: For clients under the legal age of content (varies by state) consent from from at least one parent is required for treatment of the child
- best to have consent from both, but not required
- assent should be given from child client
- parents have a right to the record of the child client, limits of confidentiality still apply
WHY: Important for the therapist to ensure consent and assent is given. Also important to ensure the therapy is age appropriate for the client.
EXAMPLE: A 13 year old girl comes to a client and asks for an appointment. The counselor explains that they cannot see the child at least one of her parents consent.
values in counseling
WHAT: General beliefs and attitudes that provide directions in life
- therapists should be aware of their own values and be careful to not impose them unto a client
- therapist should try to understand their client’s beliefs and values
WHY: Important for therapists to be aware of their own values, and be careful they’re not imposing them on their clients. Also important for therapists to understand and respect their clients’ beliefs and values. If therapist and client have opposing values, peer consultation may be needed.
EXAMPLE: A therapist is working with a client that doesn’t have a problem being very dependent and submissive to her husband. This conflicts with the therapist’s values, and they find themselves wanting to encourage the client to become more independent. The therapist realizes this would be imposing their own values on the client and instead tries to understand the client’s perspective.
vicarious liability
WHAT: A supervisor his vicariously liable and legal responsible for any mistakes that a supervisee worker under them makes in practice.
- supervisor assumes this responsibility when they agree to supervisor the person
WHY: Important to know as it raises the risk level for both parties involved. It may also encourage supervisors to train and monitor their supervisees as best as they can.
EXAMPLE: A new counselor, still under supervision, was caught having a sexual relationship with a current client. Their supervisor received punishment for this, even though the supervisor was not engaging in the unethical behavior.
