514- Ethics and Professional Issues in Counseling

Question 1

SAD Persons

Answer 1

A psychological assessment tool used to assess suicidality by looking at the risk factors of suicidal behavior. Sex: Men Age: 15-24, males 75+, females 45-54, 65+DepressionPrior History Ethanol Abuse: alcohol/drugs Rational Thinking Loss: psychosis Support System Loss Organized Plan No Significant Other Sickness: in self or significant other1 point for each;** 0-2 keep watch** 3-4 send home; call often** 5-6 consider hospitalization** 7-10 hospitalize combined with clinical judgement. Example: A patient of yours mentions suicidal thoughts. He is single, 24 years old, is currently experiencing a depressive episode, drinks every day, and recently moved far from his friends and family. According to SAD PERSONS, he scores a 6 and you try to assess whether or not the patient has a plan before deciding to hospitalize.

Question 2

Assent vs. consent to treatment

Answer 2

In clinical practice, individuals who have reached the legal age of consent (18 in the US) consent to treatment. People who cannot legally consent to treatment can assent to treatment when it is explained at their developmental level. Work with children or adults not capable of giving consent requires the consent of the parent or legal guardian and the assent of the subject. Its important to know when working with those unable to give legal consent, especially when working with vulnerable populations. Clinical example: 16 year old Jenny’s mom brings her to treatment for substance abuse concerns. The therapist discusses the informed consent document with Jenny and her mom, and her mom signs it. The therapist uses language that Jenny understands about the process of therapy and asks Jenny if she is willing to engage in the process. She says yes. Jenny’s mom has provided consent on her behalf, and Jenny has given assent.

Question 3

Bartering of clinical services

Answer 3

Part of: Ethical practice What: bartering refers to exchanging therapy for some non-monetary good or service from a client. This process can be beneficial but can create a power differential. Bartering is a boundary crossing and should be carefully considered in advance. If a counselor decides to barter, they should draw up a contract detailing the terms of the agreement in advance. In our code of ethics, bartering is alright if it does not directly result in harm, if the client accepts it, and is only arranged in practice by accepted individuals in the community. Example: A landscape architect is unable to afford therapy services, but offers to design the therapist’s new backyard in exchange for therapy services.

Question 4

Basic purpose of ethical practice

Answer 4

Primary purpose of ethical practice is to safeguard client’s well-being. Also to safeguard the public. The guiding principles of ethical practice: autonomy, beneficence, nonmaleficence (to not inflict harm intentionally), & justice can assist clinicians in this endeavor. It is important to keep this guideline in mind when navigating through a client’s situation. EXAMPLE: To protect your patients and to protect yourself as well as resisting crossing certain boundaries and knowing when to take a “mental health day” or consult.

Question 5

Confidentiality

Answer 5

Part of the ethical guidelines for psychologists, confidentiality means that the information between a patient and a therapist cannot be shared with anyone. There are a few exceptions to confidentiality, and these must be explained to the client prior to beginning treatment. Psychologists can disclose private information without consent in order to protect the patient or another person from serious harm - called the duty to warn/protect. Psychologists are required to report ongoing domestic violence, abuse or neglect of children, the elderly or people with disabilities. Psychologists may release information if they receive a court order signed by a judge or a judge’s subpoena. It is an important aspect in the client/counselor relationship.

EXAMPLE: a counselor can breach confidentiality if their client mentions recently being sexually assaulted by their father. The counselor is obligated by law to report this abuse to the proper authorities.

Question 6

Confidentiality in group or marital counseling

Answer 6

Part of ethics, law & clinical practice. Confidentiality in group and marital counseling is fundamentally different than individual setting. The therapist must still maintain confidentiality outside of this group, BUT there is no guarantee other members of group or marriage will keep information about other parties confidential. Additionally, in marital counseling the therapist should make it clear that there can be no secrets. The couple is the patient, not just the husband or the wife. Keeping secrets can harm the therapeutic alliance- THIS IS WHY ITS IMPORTANT and so that everyone is aware of expectations.

EXAMPLE: If a couple comes in for marital therapy and the husband tells the therapist that he still has an ongoing affair that he does not intend on stopping, the therapist would have to disclose this to his wife due to the no secrets rule and the effect it would have on future sessions

Question 7

Counselor competency

Answer 7

Part of ethical practice, counselor competency refers to the idea that a counselor is qualified to practice with the patient or population in question. Competence is determined by their education, training, supervised experience, credentials and professional experience. Counselors maintain competence through continuing education of current scientific and professional information in their fields. A clinician’s training is also important and for them to uphold the standards, providing services and doing no harm to clients themselves. Example: A counselor assesses a patient she hypothesizes has Borderline Personality Disorder. The counselor does not feel competent to effectively treat the patient and refers them to a colleague that is trained in DBT.

Question 8

Direct liability

Answer 8

Part of legal and ethical practice. A counselor is directly liable or legally responsible for any actions they take with a client. In other words, the counselor’s license is what’s at stake when they are delivering therapeutic services. Example: Janet was supervising a clinical counseling student and advised the student to implement EMDR, a therapy the student had not been trained in. Janet is directly liable for any harmful outcomes to the patient.

Question 9

Dual/multiple relationships

Answer 9

Dual relationships are boundary crossings when multiple roles exist between a therapist and a client. The therapist is either concurrently in another relationship with client, concurrently in a relationship with a person closely associated with the client, or promising a relationship in the future. Dual relationships impact the therapeutic alliance and/or disrupt the objectivity of the therapist. They are considered an extension of boundaries. The ACA code of ethics says that counselors should avoid entering dual relationships if it causes harm to the client. Clinical example: Denise confides in her roommate from college, who is now a therapist, that she is having suicidal thoughts. Denise begs her friend to take her on as a client since she is already comfortable with her. The therapist agrees, and there are thus multiple relationships existing between Denise and therapist, compromising the therapeutic alliance and quality of treatment.

Question 10

Duty to warn/protect

Answer 10

Part of ethical practice, the duty to warn is one of the instances in which a therapist must break confidentiality affecting the therapeutic alliance. Duty to warn means therapists have the responsibility to inform third parties if a client is at risk for harming themselves or another identifiable individual. The Tarasoff Case established that warning the authorities alone is insufficient and that the therapist must also warn the identifiable individual directly. Example: If a therapist believes the risk their client will attempt suicide is high, the therapist has a duty to protect the client by breaking confidentiality to involve other parties or have the client hospitalized.

Question 11

Ethics

Answer 11

Part of clinical practice, ethics are the standards that govern the conduct of professional members of a group of association, including therapists. Ethical standards may conflict with morals, values, and even the law. Generally, ethics are a higher standard than what is required by law. Example: The APA code of ethics dictates that therapists must wait two years following the termination of a therapeutic relationship to have a sexual relationship with clients, but it is legal to have a sexual relationship as long as clients have reached the age of consent.

Question 12

Ethical boundaries in clinical practice

Answer 12

Boundaries are a frame that protect the therapeutic relationship in an ethical practice. Boundaries may be physical (no physical contact) or behavioral (no gifts, self-disclosure). Therapists who practice ethically must use careful clinical judgment when deciding if it is beneficial to the client to cross a boundary. A boundary crossing could potentially benefit the client, be neutral, or potentially harm the client. A boundary violation is a boundary crossing that harms the client. You must document the boundary if you decide to cross it as well as your reason for doing so. Example: A therapist agrees to conduct a therapy session while walking because movement helps the client think and dispels some of the client’s anxiety about speaking honestly. This is a boundary crossing that benefits the client.

Question 13

Ethics-sensitive practice

Answer 13

A model of clinical counseling where the clinician is mindful of ethnic group practice and models understanding. Part of ethical practice, an ethnic-sensitive approach or practice is one that considers how the culture of a patient may impact their worldview, attitudes, beliefs, presentation of symptoms, or appropriate treatments. Counselors must be careful and self-aware enough not to apply their own worldview to the clients, but instead, attempt to understand their client’s worldview and the factors that influenced it. It would be unethical to ignore these diverse issues when it comes to clients and practicing in this manner leads to better outcomes. Example: Tiffany is an Asian American client who often talks about her parents’ opinions of her choices in therapy. An ethnic-sensitive therapist will not be dismissive of these concerns but will understand that her worldview is collectivistic.

Question 14

HIPAA Compliance

Answer 14

The Health Insurance Portability and Accountability Act. It establishes national standards to protect individuals’ medical records and other personal health information. Psychotherapy notes are protected under HIPAA and counselors should use technology that is compliant.
Example:

Question 15

Legal aspects of informed consent

Answer 15

The person giving consent must have the capacity to give consent. Consent must be given in a voluntary nature without coercion. To cover legal bases of informed consent, a therapist must discuss the limits of confidentiality, the nature of therapy, and the fee structure. Clinical example: A new therapist forgets to include her rate, when payment is expected, and whether she bills insurance on her informed consent paperwork. She has not fulfilled the legal requirements of informed consent.

Question 16

Licensure vs. certification

Answer 16

Part of ethical practice, licensure is a mandatory requirement to be a legal practitioner and is given out by a government board after rigorous education, training, and supervised practice. Certification is a voluntary process of acquiring knowledge and/or skills typically from a professional organization or association. Typically the requirements for certification are less rigorous than licensure. Clinical example: Prior to beginning a private practice, Erin attended a graduate program, completed supervised internship hours, and sat for a licensure exam to ensure gained licensure from the South Carolina Board of Licensure and, therefore, be a legal practitioner. She also secured certification in TF-CBT.

Question 17

Malpractice

Answer 17

Part of ethical practice, the failure of a counselor to provide the standard of care expected when treating an individual that results in direct damage to the patient. Example: Administering a treatment one has not been trained to administer can result in malpractice. For example, if a patient presented with PTSD and a therapist who was not trained in EMDR administered that therapy. Malpractice is professional misconduct or negligent behavior on the part of the clinician that may lead to legal action. It’s a type of civil liability law under which parties allegedly injured in a professional relationship may seek monetary compensation for their damages. There are four essential elements of malpractice: (1) there must be a duty or obligation of the professional to the client; (2) there must be damage to the client; (3) the professional must have deviated from acceptable (or standard) practice or professional code; and (4) there must be a direct link between the damage to the client and the behavior of the clinician.

Question 18

Morality

Answer 18

Individual’s internal value system for what is right & wrong & what constitutes right & proper conduct. In the same way that it is important for a counselor not to impose their values on their client, it is equally important that they do not impose their morality upon their client.

EXAMPLE: A therapist believes that cheating on your girlfriend is wrong, but does not judge his client for cheating or try to convince him not to do it. The therapist recognizes that him viewing cheating as wrong is part of his morals. The client does not necessarily share these morals.

Question 19

Peer consultation

Answer 19

Part of ethical practice and a risk management approach, consulting with a trusted network of colleagues or peers on difficult cases or potential boundary violations is recommended and can ensure counselors are not acting unethically or imposing their worldview on their clients. Consultation ensures clinicians are practicing within their boundaries and making sure their biases are not influencing their decisions. Example: You notice a patient you are treating is evoking some strong emotions in you and suspect countertransference. You consult with a group of trusted peers to discuss the case and get recommendations on whether or not to refer the patient.

Question 20

Power dynamics

Answer 20

Refers to the natural power differential that exists between the clinician and the client. Ethical practice aims to ensure that clients are not harmed or exploited through this power differential.

Question 21

Privileged communication

Answer 21

Refers to the confidential communication between therapists and their clients; it is protected by law from being shared with others, although there are some exceptions (duty to warn, suspicion of abuse, court order). The client has the privilege or right to determine if and when their protected communication is shared. Example: A patient shares with you in session that he was sexually assaulted as a child. That information is privileged and just be kept confidential by the therapist.

Question 22

Pro bono service

Answer 22

Service that therapist provides for free, sometimes to members of the community who may not be able to afford their services. Counselors are highly encouraged and sometimes required per ethical mandate, to contribute to their community by providing pro bono services. It is important to establish boundaries and avoid allowing either party to take advantage of the situation. Example: A therapist keeps one afternoon of appointments available for pro bono services as a service to his community.

Question 23

Professionalism

Answer 23

Safeguarding the integrity of the counselor-client relationship is why its important. Aspects of professionalism include appropriate dress and proper behavior when interacting with a client, and appropriate behavior when in the community. One may be unprofessional without necessarily being unethical, but frequently the two are tied together. Example: As part of professional practice, therapists should arrive on time, use respectful language, and dress appropriately.

Question 24

Reporting child abuse

Answer 24

Licensed therapists are mandated reporters and, therefore, required by law to report any suspected cases of child abuse to the proper authorities (DSS, THE POLICE, OR BOTH DEPENDING ON WHERE YOU LIVE) within 24 hours. This should be outlined in the informed consent process and discussed with the client when explaining the limits of confidentiality. Documentation of such report should be made. Counselors who fail to report may be subject to legal and professional sanctions. Clinical example: A patient reveals that she is worried her boyfriend is touching her children in a sexual way. The therapist is required to break confidentiality and report this suspicion to the proper authorities.

Question 25

Self-monitoring of ethical practice

Answer 25

Counselors should be aware of ethical codes and monitor themselves to ensure that they are practicing ethically.
ethical practice occurs on a continuum and clinicians should be aware of where they fall on this continuum. Counselors should not rely wholly on self-monitoring, and should also use peer consultations and reviews. Relying solely on self-monitoring could result in rationalization and justification for unethical behaviors. Clinicians should be aware of what is outside of their scope and should continue to monitor themselves so they practice what is inside their scope. Example: A therapist accepts a gift offered by a client. Later, she considers her clinical decision and whether it was ethical. She feels confident in the self-monitoring of her behavior, but she reaches out to a colleague to ask for a second opinion anyway.

Question 26

Sexual intimacies with former clients

Answer 26

Intimacies with current clients are prohibited while sexual intimacies with former clients are allowed 5-7 years after termination of therapy. It is usually best to avoid. Therapist cannot end therapy with the promise of a future sexual relationship (constitutes a multiple relationship), and must ensure that there is minimal risk of harm to their former clients. Example:

Question 27

Tarasoff case

Answer 27

Landmark case that resulted in a clinician’s duty to warn. A psychologist was treating a patient who made a threat to kill an identifiable third party. Psychologist was unable to commit the patient and the patient killed the third party. The victim’s family sued, and the ruling requires that a therapist breach confidentiality in cases where the welfare and safety of a readily identifiable 3rd party is involved. When a client communicates a threat directed at an identifiable third party to their counselor and the counselor believes that the person is in imminent danger, they must warn the individual directly instead of simply alerting authorities. This case placed further limits on the client’s right to confidentiality. Example: could be similar to duty to warn and protect but then add a sentence about because of the Tarasoff case led to these findings.

Question 28

Treatment of minors

Answer 28

Parental consent (preferably from both parents) is required for the treatment of individuals under the age of sixteen, the one exception being crisis situations. Parents have a right to the record of their child unless they sign a waiver giving up that right. The therapist should ensure that therapy is age appropriate. *add something about who holds the record. add in assent. The limits of confidentiality differ for that of an adult. Example:

Question 29

Values in counseling

Answer 29

Part of ethical practice, values are beliefs and attitudes based on our culture and individual preferences that provide direction for everyday living. In ethical counseling, therapists should be aware of their own values, attempt to understand their clients’, and avoid placing their own value system on the client. It is important that the therapist not have a reaction to a client’s values in order to avoid countertransference. A therapist should seek training when they are not competent in an area where their values aren’t in line with the client’s preventing harm.

Question 30

Vicarious liability

Answer 30

In clinical practice, if a therapist in training practices under an institution’s or therapist’s license, that institution or therapist has liability for the trainee’s actions. For example, supervisor is directly liable for things such as giving inappropriate advice to their trainees or allowing their trainees to practice at a higher level than they are competent at. Clinical example: Janet was supervising a clinical counseling student and advised the student to implement EMDR, a therapy the student had not been trained in. Janet is directly liable for any harmful outcomes to the patient.