Ethics Flashcards
SAD Persons
WHAT- An assessment tool used to evaluate an individuals risk of suicide and need for higher care. It is an acronym that stands for:
S ex
A ge
D epression
P rior psych history
E xcessive use of substances
R ational thought loss
S eperated/widowed
O rganized attempt
N o support system
S ickness
WHY- It is important that clinicians have tools such as these available to assess a client that is displaying risk to ensure you are able to proceed safely
EX- A 55 year old divorced man with a history of depression, substance use, and social isolation comes into therapy because he is hopeless due to financial challenges. He would score high when the therapist uses the SAD PERSONS assessment and require intervention to ensure safety
Consent vs Assent
WHAT- Consent is a legal agreement and statement of approval given by an individual, typically above the age of 18 in the US, to receive treatment. Assent applies to minors or those not mentally competent who are providing approval for treatment but consent from a parent or guardian is also legally required. A clinician will want to explain the nature of therapy and the risks in age appropriate terms to the specific client. Consent and assent are ongoing processes and can be revoked at any time
WHY- Consent and assent are essential to ethical practice to ensure that clients are informed to and making the educated decision to get treatment knowing what to expect. Based on the ethical principles autonomy and beneficence.
EX- A therapist begins working with a 14 year old client. The clients mother brought them into therapy and gave consent to proceed with overall treatment. With the approval from the parent, the therapist would now need to ask the client for assent to proceed with therapy and to into into the therapeutic alliance
Bartering for Clinical Services
WHAT- When a clinician accepts payment for professional services in goods or services instead of monetary payment. This is considered acceptable when the value exchanged is fair and mutually agreed upon in a detailed writing agreement/contract.
WHY- Bartering for clinical services is important for clinicians to consider because it can be ethically challenging with the varying interpretations of what is fair and risk of a boundary crossing or harm to the therapeutic relationship. Clinicians should only barter if it does not result in exploitation or harm
EX- A client could not pay for therapy because their insurance had lapsed. He is skilled in lawn care so an agreement was written up between the client and the therapist in which he would provide landscaping services in exchanges for therapeutic services.
Basic purpose of ethical practice
WHAT- The basic purpose of ethical practice is to safeguard the wellbeing of the client and the public. The 4 principles that are essential for clinicians to uphold in order to protect clients are autonomy, beneficence, non maleficence, and justice. Clinicians uphold this through informed consent, consultation, and documentation to ensure best outcomes for patients
WHY- It is essential that practitioners keep the basic purpose of ethical practice in mind while navigating through each clients situation to ensure best care and to not cause harm
EX- A therapist keeps detailed and updated documentation for every session with their client Silvia. This practice ensured that details remain fresh and accurate, minimizing the risk of forgotten nuances regarding her behavior and the accurate recordings helped to influence the efficacy the treatment plan and improved her wellbeing
Confidentiality
WHAT- The legal and ethical responsibility to keep a clients information private. There are a few exceptions to confidentiality which include 1. If the client expresses the intent to harm themselves or a specific other person the therapist is legally required to report it 2. If there is abuse involving vulnerable population which includes minors, the elderly, and mentally disabled the therapist is legally required to report it 3. If the client is involved in a court case and the clinician is subpoenaed by a judge to disclose information. It is important that the therapist address confidentiality and its limitation during informed consent/intake to ensure transparency and mutual understanding
WHY- Confidentiality is necessary for effective therapy as it creates a safe space for clients to freely express themselves.
EX- You are treating a minor and they express to you that their father is sexually abusing them. This situation would be an exception to confidentiality and you would be legally required to report this to the authorities to ensure the safety of the client.
Confidentiality in group and marriage counseling
WHAT- Confidentiality is the legal and ethical responsibility to keep your clients information private. Confidentiality in marriage and family counseling is nuanced. The therapist must avoid meeting with one member/partner without the others knowledge or consent or ensure session stay balanced and equal. Additionally, in marriage counseling the therapist must make it clear that there can be no secrets. The therapist maintains confidentiality outside of the group/partnership, but has no control or guarantee over what others say outside of sessions to keep the information private.
WHY- Confidentiality is necessary for ethical integrity, legal compliance, and meaningful therapeutic outcomes. This knowledge is important because keeping secrets within marriage counseling can harm the therapeutic alliance
EX- A couple comes in for marital counseling and are made aware that in marital counseling there can be no secrets. After this is made clear, the husband tells the therapist separately that he still has an ongoing affair that he does not intend to stop. The therapist would have to disclose this to his wife due to the no secrets rule and the effect this information would have on future sessions
Counselor competency
WHAT- Refers to a counselors ability to practice well and perform according to the standards of the profession. This includes but is not limited to: knowledge base, technical skills, practicing within scope, committed to continued education, and understanding cultural differences. Refers to the ability to perform physically, mentally, and emotionally which includes self care and self-monitoring to ensure we are showing up for each client.
WHY- It is essential to uphold counselor competency to ensure we’re giving the best care and services to clients and avoiding harm
EX- Fred is a CBT therapist and has a client come in needing treatment for BPD. Instead of treating the client, he refers out because he is not certified in DBT and it would not be in his scope of practice since he does not have the knowledge base to provide the best treatment possible for the client
Direct Liability
WHAT- A term used to refer to where the burden of responsibility lies within a therapeutic context. Direct liability is a legal principle that holds the therapist directly responsible for their actions and are held accountable professional and potentially legally under their license. The therapist themselves are responsible if they fail to meet their duty of care through negligence, malpractice, misconduct, etc.
WHY- Direct liability is important because it holds accountability for license holders if an unethical act is committed. Ensures that license holders are upholding the best standard of care and will receive consequences if not
EX- A therapist is being investigated by the state and is at risk of losing their license to practice as a result of overbilling clients/fraud.
Dual relationship
WHAT- Occurs when the therapist has another type of relationship with a client that goes beyond that of the therapeutic one
WHY- It is considered best practice that dual relationships be avoided if possible as it can have impacts on the therapeutic alliance and may impair the objectivity of the treatment relationship
EX- A therapist and one of their clients has children that go to the same school, therefore they often cross paths outside of therapy and tend to get invited to the same social events
Duty to warn
WHAT- Outcome of the Tarasoff case, refers to the legal and ethical obligation of mental health professionals to warn/protect a third party who their client has expressed intent to harm as well as notify the authorities
WHY- The Tarasoff Case established that warning the authorities alone is insufficient and that its important the therapist must also warn the identifiable individual directly to ensure safety measures are taken. This would be one of the situations where the counselor is forced to break confidentiality
EX- Your client said that he is going “to kill” his estranged wife if she gets custody of the children in their divorce case. You MUST tell the estranged wife as well as law enforcement of this claim.
Ethics vs. Morals vs. Values
WHAT – Ethics, morals, and values are related concepts but have distinct meanings. Ethics is a system of principles that govern how people should behave, often established by a group, society, or profession. Example: A therapist follows ethics by maintaining patient confidentiality. Morals are personal beliefs about right and wrong, influenced by culture, religion, or upbringing. Example: An individual may believe that lying is always wrong, even if it prevents harm. Values are core principles or standards of what we prioritize in life. Example: Someone who values family over thier career might spend more time at home.
WHY – For a strong therapeutic alliance, it is critical that the clinician not impose their personal ethics, moral, or values onto the client
Licensure vs certification
WHAT- Licensure is a requirement by law to be a legal practitioner which is given out by a government board after rigorous education, training, and supervised practice. Certification is a voluntary process and is the acknowledgment that indicates a person has meet qualifications of knowledge or skills to perform a specific job or task.
WHY- It is important to understand the difference so one can navigate and plan out their career path and know what each allows you to be able to do.
EX- John is licensed as a counselor in South Carolina. This license is overseen and controlled by the SC Board of Counselors. John is also certified in PTSD training. This certification states that he completed all the necessary coursework and training but is not monitored or overseen.
Malpractice
WHAT- Is the legal term referring to negligence or misconduct in which a practitioner fails to meet required standards or care, resulting in the harm of the client. The essential ingredients to malpractice are the 4 Ds: Duty (to protect), Deviate (from normal practice/tx), Damages (has this caused harm), Direct (directly impacted the client).
WHY- Malpractice is important for clinicians to know and take seriously to avid any legal action or harm to clients
EX- A client comes into therapy needing DBT treatment. The therapist is not trained in DBT but wants the business so proceeds with trying to treat the patient using this method anyway. After many sessions, the client is not improving and feels like therapy is not working for them and feels even worse. The therapist is displaying malpractice by practicing out of scope and causing harm to the client
Peer consultation
WHAT- Peer consultation is the process where counselors engage and consult with other professional peers about challenging cases, sharing insight, offering feedback and more which helps everyone improve their practice and mitigates risk. Confidentiality is still maintained during consultation
WHY- Peer consultation is essential for promoting professional growth, preventing burnout, and creating a supportive environment and community for enhancing competency.
EX- A therapist starts seeing a client that seems to meet criteria for Borderline personality disorder. Although the therapist was trained to treat this disorder, this would be her first time treating it. The therapist uses peer consultation with her peer group to see if anyone has had direct experience treating the disorder to get feedback and guidance to proceed with confidence.
Privileged communication
WHAT- Refers to the confidential communication between the client and therapist that are kept private and protected from disclosure until the client provides consent or in the few situations that are exceptions to confidentiality
WHY- Privileged communication is essential to allow space for clients to share information without the fear it will be exposed. This fosters open and honest communication which enhances the therapeutic relationship and lead to positive client outcomes
EX- A client shares that they have been continuously cheating on their exams at school. The therapist cannot disclose this information as it does not cause direct harm to the client or anyone else
Pro Bono services
WHAT- Professional services that a therapist provides for free. Not ethically required but it is encouraged for clinicians as a means to ensure that financial barriers do not prevent individuals from getting access to mental health care. It is important in these situations to establish boundaries and avoid allowing either party to take advantage of the situation.
WHY- An individual sought therapy but could not afford it because they don’t have insurance. The therapist offers to provide 5 sessions to the client pro bono/free of charge so they individual can get some assistance.
EX- Offering pro bono services is important as it can enhance a counselors understanding of diverse client needs
Reporting Child Abuse
WHAT- Licensed therapist are mandated reporters so they are legally required to report any suspected cases of child abuse to the proper authorities within 24 hours. This should be outlined in the informed consent process and discussed with the client when explaining limits to confidentiality.
WHY- It is important to recognize signs of abuse to ensure a child’s safety, and essential to report it if told or suspected. Counselors who fail to report may be subject to legal and professional consequences.
EX- A 9-year-old is in therapy and his therapist notices suspicious bruises on his arms and legs. When the therapist asks, the child shuts down and doesn’t want to talk about it. The therapist discusses the concerns with the mother who also doesn’t want to discuss the issue. The therapist informs the mother they are a mandated reporter and must report suspicions of abuse. The mother explains that it’s not her but her ex-husband. The therapist allows the mother to call DSS in the office to make the report before leaving
Self-monitoring of ethical practice
WHAT- Behavioral management in which a professional is constantly making ethical decisions and practicing within scope. This includes self-awareness, reflection, and accountability.
WHY- Self monitoring helps clinicians uphold standards of ethical codes and prevents causing harm to clients
EX- Tom, LPC feels himself growing exhausted by his client and allows his mind to wander during the session. Tom knows he must find new ways to engage this client and consults with a peer for recommendations. Additionally, before their next session, Tom makes a note to engage in a mindfulness exercise so as to be fully present for his client
Sexual intimacies with former clients
WHAT- Sexual intimacies with current clients are prohibited, while sexual intimacies with former clients has ethical codes that state that sexual contact has a statute of limitations after termination (2 years in SC)
WHY- It is important for clinicians to remember these codes to prevent any misconduct and know it is in best practice to stick with the policy that once a client always a client
EX- The therapist runs into a former client 3 years after terminating therapy and finds her attractive. The therapist recalls the client struggled with depression and met criteria for BPD. With all this information in mind he decides to keep the relationship strictly professional to avoid any harmful consequences to the former client
Tarasoff case
WHAT- Legal case that established a clinician’s duty to warn. A university grad student confided in this therapist that he was going to kill Ms. Tarasoff. The therapist informed police but the murder was still carried out.
WHY- The Tarasoff Case established that warning the authorities alone is insufficient and that its important the therapist must also warn the identifiable individual directly to ensure safety measures are taken. This would be one of the situations where the counselor is forced to break confidentiality
EX- An unstable individual you are treating, meeting criteria for a personality disorder, comes into session and tells you they are planning to kill their wife that night. Due to the precedent established by the Tarasoff case, you know you have a duty to warn/protect. You alert the authorities as well as the client’s wife
Treatment of Minors
WHAT- If someone is under 18 they are a minor and can only assent to treatment, the parents and guardians must consent. The one exception being crisis situations. The parents/guardians must be aware of what is going on in treatment and have rights to the child’s records.
WHY- This is important for clinicians to remember the minor is the client and must balance the child’s right, parental involvement, and legal obligations
EX- Your client is a child in the middle of a battle for custody with divorcing parents. The counselor must remember that while the minor is their client, there will be pressure from and an expectation by the parents for shared information. Within the boundaries of this limited confidentiality, is your duty to professionally manage the best interests of your client.
Vicarious Liability
WHAT - A term used to describe where the burden of responsibility lies within a therapeutic context. Vicarious liability is a legal principle that holds individuals and organizations accountable for the negligence, malpractice, or misconduct of their employees. Within counseling, the licensed professional is responsible for the actions of anyone working under their license
WHY- Vicarious liability is important as it adds risk to a license holder and should be kept in mind for teaching ethics and hiring purposes.
EX- A counseling supervisor finds out that one of their trainees is engaging in sexual intimacies with one of their clients. Even though the trainee is the one engaging in the unethical behavior, the supervisor is held responsible and punished for the act
