Final Exam (Mike's study guide) Flashcards
Homicide
o Duty to protect
o Permitted to breach
o Mandated to take steps
Suicide
o Mandated or permitted to breach
o Consult/Document
• Case by case basis
o Mandated to take steps
Bellah v Greenson
o It is unclear if Tarasoff applies to suicide
• Statute of limitation ran out so we do not have certainty
Goal of Crisis Intervention
o To bring client back to pre-morbid state, and to restore individuals to pre-crisis functioning
Menendez Case – confidentiality ruling
o Once therapist is threatened, therapy is over
• Oziel was threatened, and at that point therapy was over so the tapes were not part of therapy
Counter-Transference: 3 types
- CT to client’s transference – objective
- CT based on therapist’s archaic conflicts – subjective
- CT based on reality – objective
Informed Consent
good for length of treatment
Release of information
good for 12 months
Get consent for consult
when not using identifying information
Do not need consent for consult
when not using identifiable information
Standard of Care
getting a professional consult
Bracketing
suspend one’s own judgment for client’s sake
Unruh civil right act
damages 3x amount awarded
Conscience clause
religious freedom
Death with dignity
legal in CA
5 Limits of Confidentiality
o Child abuse o Elder abuse o Dependent abuse o Threat of harm to self o Threat of harm to others
Informed Consent
must be given at the outset of treatment (no later than 3rd session)
Sexual exploitation brochure
“Therapy never includes sexual behavior”
When is a psychotherapist required to breach confidentiality upon receiving a report from a patient he or she has been sexually abused by a former therapist?
Child/dependent/elder abuse
Barter – two types:
o 1. Products
o 2. Services (more risky)
DIRE exception
Minors may be seen for psychotherapy without parental consent if the therapist believes without the treatment the minor’s situation may become dire (e.g., suicide, homicide)
How to report child abuse – two required actions:
o 1. Immediately by phone
o 2. Prepare and send report (within 36 hours)
Daniel v Daniel (1990) Family Code 3151
- The child’s counsel appointed by the court may hold privilege
- Judge may appoint to pull therapist out of the middle
Upon becoming aware of elder or dependent abuse, when do you have to make the initial phone call to APS?
Immediately
When to send pre-printed report to APS after becoming aware of elder/dependent abuse?
Within 2 working days
7 Types of mandated elder abuse reporting:
o 1. Physical and sexual assault o 2. Neglect o 3. Abandonment o 4. Isolation o 5. Financial o 6. Self neglect o 7. Abduction
Type of permitted elder abuse reporting:
o 1. Psychological abuse
CA “Elder” definition:
CA resident 65 and older
CA “Dependent” definition:
CA resident between ages 18-64
o Unable to care for oneself for a variety of reasons
• Mentally or physically challenged
Three ways a client’s records can be sought:
o 1. Issuance of subpoena “ad testificandum”
o 2. Issuance of subpoena “duces tecum”
o 3. Court order (more powerful than a subpoena)
Subpoena duces tecum
Command to appear in court and bring specific documents
Notice to consumer
client knows his or her records are being sought
Valid subpoena
Notice to consumer Client knows about subpoena Get written release if possible Properly served by court clerk Issued by attorney – usually in civil proceeding
Court order
power of the judge
Subpoena ad testificandum
Legal demand to give testimony
Four elements of proper termination
- CCC – DDD (consult and document)
- No current crisis
- Reasonable notice
- Proper referral
Three elements of proper referral
- Available
- Similar fee
- Theoretical orientation
When can you forgive the client co-pay?
When you have informed and cleared it with the insurance company
“Rational thinking loss”:
God told me to jump off a building, but told me I will not die doing this
“Irrational thinking”:
Youthful exuberance – I haven’t booked my first commercial yet, and I have been in Hollywood for three weeks
“Death by suicide”:
Currently accepted terminology
Informed Consent:
Good for length of treatment
Release of information:
Good for 12 months
Beliefs:
Personal values do not need to be changed, must follow ethics code
Behaviors
Must abide by the ethics codes related to discrimination
In CA, HIV/AIDS is not considered Tarasoff
True
Informed consent is suggested to be in writing, but is not law
True
Patient access to records:
Access to view – 5 days
Access to copy – 15 days
Summary of records – 10 days
Four elements that make Informed Consent valid:
- Capacity
- Comprehension of information
- Voluntary
- Document
Elements in Informed Consent
Office policies Client’s rights Limits of confidentiality Fees Insurance Emergency Cancellation policy Signature
Bracketing:
Managing personal values so they do not contaminate the counseling process
Conscience Clause:
A legislative provision that relieves a person from compliance on religious grounds
Julea Ward
dismissed from counseling program after refusing to counsel gay student
Dueling ethics codes:
Non-discrimination vs
Scope of competence
Forgiving and collecting the client co-pay
Must keep insurance company informed
May not forgive client co-pay as a contract for treatment
“Insurance” diagnosis
Must give correct diagnosis even if insurance company refuses reimbursement
Insurance companies don’t want to pay for personality disorders or z-code
Billing for missed sessions
Ethics: Confidentiality with billing statement
Legality: Indicate unattended session on statement
“Therapy never includes sexual behavior” – brochure
Give to client who reports sex with a former therapist
At client’s request, a staff person may support or assist in reporting the incident, but should not pressure the client to report
Record keeping
Must keep records for 7 years from cessation of treatment, and 7 years past majority for minors
Court Order
Overrides need to obtain client consent
A demand issued by a judge
Must respond with or without client consent
Holder of privilege
Older minors – generally may hold their own privilege
Younger minors – generally parent or legal guardian holds privilege
General rule – decided in court by judge
3rd Party Rule:
US legal theory – people who voluntarily give information to 3rd parties have “no reasonable expectation of privacy”
Failure to report abuse
Misdemeanor
6 months in jail or $1000 fine – or both
Purposely not report abuse
Misdemeanor
1 year in jail or $5000 fine – or both
Child abuse
Reasonable suspicion
Notify APS immediately by phone
Prepare and send report within 36 hours
Divorce
dissolution
Defendant
respondent
Plaintiff
petitioner
Alimony
spousal support
Treating minors without parental consent (must have both)
- Must be 12-17 years old
2. Must be mature enough to have treatment (or danger to self or other without services)
Duty to warn vs duty to protect
Duty to warn refers to a counselor’s obligation to warn identifiable victims
Duty to protect is a counselor’s duty to reveal confidential client information in the event that the counselor has reason to believe that a 3rd party may be harmed
Rule of least restrictive treatment
Before someone is hospitalized, is it possible to: Increase sessions support system medication consult agreement adjunctive treatment
When to Consult
Client deterioration Legal and ethical issues CT/burnout Uncertainty about diagnosis Lack of improvement Red flag issues:
Standard of care – four elements
- Reasonable therapist
- Ethics codes
- Statute
- Case law
Professionalism:
Working within own expertise
Consultation or supervision in new area
Maintaining knowledge of standard of care
Maintaining personal mental health
Practicing self-care
Must practice professionalism when off-duty
Preventing Burnout – physical, emotional, mental exhaustion
Self-preparation for disappointments and lack of confidence
Evaluate unrealistic self-expectations
Continue replenishing: vacations, hobbies, active relationships, balance
Consultation
Personal therapy
Work within competency
Patriot Act:
Federal court order sought from a federal judge – if approved, client’s records are sought
We are not required to provide this information to anyone other than the person seeking it
One time only
Child custody:
Legal – decisions
Physical – location
Types of child custody
Intact
Domestic partnership – adoption
Joint
Sole
