INTERVENTION: Subdomain 4 -- Ethics/Legal Issues Regarding Therapy Flashcards
1
Q
What is covered in the APA Code of Ethics?
A
(APA, 2017)
- Resolving ethical issues
- Competence
- Human relations
- Privacy and confidentilaity
- Advertising and other publics statements
- Record keeping and fees
- Education and training
- Research and publication
- Assessment
- Therapy
2
Q
What are the 5 general principles of the APA code?
A
APA, 2017
-
Principle A: Beneficence and Nonmaleficence
——Provide benefit and do no harm (while partaking in self-care) -
Principle B: Fidelity and Responsibility
——Establishment of trust
————Consulting and referring when appropriate
——Responsibility to community
——Pro-bono work -
Principle C: Integrity
——Honesty (don’t commit fraud, kids) -
Principle D: Justice
——Duty to exercise judgement
——Watch bias
——Work within one’s competence -
Principle E: Respect for Rights and Dignity of Others
——Rights to privacy and confidentiality
——Self-determination
——Diversity
3
Q
What are the ethical considerations around informed consent?
`
A
(APA, 2017)
- Must be given to client
- Course of therapy, fees, limits of confidentiality, and (when appropriate) name of supervisor
- With family therapy, confirm who clients are and relationships
- With group therapy, explain role of each member and limits of confidentiality
4
Q
What are the ethical considerations around someone receiving services elsewhere?
A
(APA, 2017)
- Be cautious when deciding whether to provide services to a client who is already receiving other services
- Consider the client’s welfare
- Discuss issues around this with the client
- Consult with the other provider(s) when possible
5
Q
Should you have sex with your client?
A
(APA, 2017)
No. Just, don’t.
- Sex/intimacies is never allowed with current clients OR relatives/significant others
- Can’t accept people you’ve had intimacies with previously
- May engage after two years have passed since termination
——You bear the burden of proof that there has been no exploitation
6
Q
What are the ethical considerations around termination?
A
(APA, 2017)
- Make reasonable efforts to provide resolution if terminating early
- When:
——Client no longer needs services
——Not likely to benefit
——Being harmed by therapy
——Therapist feels threatened/endangered by client or relative
——Pre-termination counseling and suggest alternative services
7
Q
What is the feminist code of ethics?
A
(Rave & Larson, 1995)
- Additive to APA Code
- Must consider impact of society on problems brought to therapy
- Be aware/Acknowledge:
——Cultural diversities and oppressions
——Power differentials
——Overlapping relationships and client confidentiality - Remain accountable and practice self-care
- Actively seek multiple avenues for change
8
Q
What is the purpose of boundaries in therapy?
A
(Barnett, 2014)
- Boundaries exist to provide a sense of safety for the client
9
Q
What are ways that people handle boundaries?
A
(Barnett, 2014)
-
Avoiding a boundary –> NEVER engaging in a behavior
——(e.g., never touching a client) -
Boundary crossing –> Transgression NOT considered inappropriate, unwelcome, or harmful
——(e.g., potentially hugging a grieving client if carefully considered) -
Boundary violation –> significant potential harm or is unwelcomed by therapist
——(e.g., sex with a client)
10
Q
How do you know what is a boundary violation or a boundary crossing?
A
(Barnett, 2014)
- Some actions are clear violations (sex with clients, come on friends just don’t), but other things require careful deliberation
- When making decisions about boundary crossing consider:
——Client’s issues
——Intent
——Whether the client welcomes the action or not
——Psychologist’s theoretical orientation
——Diversity issues
11
Q
What is the “slippery slope” idea of boundary violations?
A
(Barnett, 2014)
- Initially sexual relationships were viewed as mismanagement of countertransference by the therapist
- Milder boundary crossings would lead to a “slippery slope” of worse actions
——Therapists urged to be highly conservative to avoid accidentally having a sexual relationship with a client - Recent research does NOT support “slippery slope” idea
——Rigid adherence can be detrimental/damaging to relationship
————▪ (i.e., refusing a small gift from client)
12
Q
Why do therapists have sex with their clients?
A
(Barnett, 2014)
- Why do therapists have sex with clients?
——Naivety about ethics standards
——Problems with professional competence
——Character issues
13
Q
What should we do when considering boundary issues?
A
(Barnett, 2014)
- When considering boundary issues we should consult
14
Q
How do we balance the codes of ethics?
A
(Knapp et al., 2013)
- Some rely too heavily on the Ethics Code (see it as law)
- Others disproportionately emphasize their personal beliefs and treat clients like they were friends.
- Both extremes can have serious negative consequences
- Strive for balance
- Ideally, integrate APA code with own personal values
——(Handelsman et al., 2005) added a terrible colonizer metaphor here about
assimilation and acculturation.
——The takeaway is –> we need to learn to adapt the ethics of our field into our lives
15
Q
What is the deal with ethics code violations?
A
(APA, 2003)
- Not necessarily equal to violations of law
- Some states have codified ethics into law
- Means membership to APA and other psych associations at risk
- Can lose license depending on violation
- Violating law can lead to losing license
- If ethical responsibilities conflict with law you must declare your commitment to the APA Ethics Code
——Consult legal advice
16
Q
Can you choose your clients?
A
(APA, 2003)
- Free to choose (unless under contract)
17
Q
What are the considerations of confidentiality?
A
(APA, 2003)
- Supervisors responsible for supervisees
- Privilege –> legal concept – bars disclosure of confidential information in legal proceedings and can only be asserted by client
- Confidentiality –> duty to not disclose info about the client
- Can break when someone threatens to harm someone else (varies by state)
——Duty to Warn - Acknowledging someone is your client is a breach
18
Q
What do you do when a client dies?
A
(APA 2003)
- Client death – maintain files confidentially for period dictated by law
- Keep records confidential even after death
19
Q
What are the laws around maintaining records?
A
(APA 2003)
- Law requires maintenance of records of services
20
Q
What is abandonment?
A
(APA 2003)
- Inappropriate ending of services
- Abandonment – specified by law
- Can include inappropriate termination or lack of referral
21
Q
What are the ethical concerns about closing a practice?
A
(APA, 2003)
- Clients legally allowed access to records for a period of time
- Try to refer/terminate active sessions
- Death/sudden illness – have a co-therapist (provide referrals/store client records)
——Collecting overdue bills or giving a third party who is paying for therapy legal rights should be agreed at outset
22
Q
What happens in legal cases?
A
(APA, 2003)
- Subpoena (legal document)
—–Requires psychologist to give documents or testimony
——Can be challenged
——Do not necessarily do away with client privilege (ability to deny confidential
information to be disclosed) - Psychologist CAN assert privilege on behalf of client until the submit waiver to the court to submit documents
- Failure to comply/respond can result in penalties
——But can appeal (with legal advice) - Can be called to be “expert” or “fact” witness
——Expert witness: give an opinion or do assessment
——Fact witness: testify what’s in the client’s records
23
Q
SUBDOMAIN 4 CITATIONS
Not including the APA citations
A
SUBDOMAIN 4 CITATIONS
Not including the APA citations
24
Q
Rave & Larson, 1995
A
Rave & Larson, 1995
- What is the feminist code of ethics?
25
Q
Barnett, 2014
A
Barnett, 2014
- What is the purpose of boundaries in therapy?
- What are ways that people handle boundaries?
- How do you know what is a boundary violation or a boundary crossing?
- What is the “slippery slope” idea of boundary violations?
- Why do therapists have sex with their clients?
- What should we do when considering boundary issues?
26
Q
Knapp et al., 2013
A
Knapp et al., 2013
- How do we balance the codes of ethics?
