Managing Legal and Ethical Obligations within the Therapeutic Relationship Flashcards
An MFT associate is beginning a new supervision relationship with a therapist who has a private practice. To meet legal and ethical requirements:
Select one:
A.
the supervisor must have been licensed as an MFT for at least two years.
B.
the associate must be provided with at least one hour of individual supervision in every week he sees clients.
C.
the supervisor must pay the associate for his services.
D.
the supervisor must sign a Responsibility Statement for Supervisors.
Answer D is correct: CCR Section 1833.1 requires supervisors to complete and sign the Responsibility Statement for Supervisors prior to commencing supervision.
Answer A is incorrect: While supervisors must be licensed for at least two years, they do not have to be licensed MFTs. They may also be licensed psychologists, LCSWs, LPCCs, or board-certified psychiatrists.
Answer B is incorrect: MFT associates may receive either individual or group supervision.
Answer C is incorrect: MFT associates do not have to be paid for their services, although most are.
The correct answer is: the supervisor must sign a Responsibility Statement for Supervisors.
In California, which of the following is legally identified as a “holder of the privilege”?
Select one:
A.
The patient’s guardian or conservator.
B.
The patient’s therapist.
C.
The parents of a patient under age 18.
D.
A judge or officer of the court.
Answer A is correct: As defined in EC Section 1013, the “holder of the privilege” is: “(a) The patient when he or she has no guardian or conservator. (b) A guardian or conservator of the patient when the patient has a guardian or conservator. (c) The personal representative of the patient if the patient is dead.” In other words, the patient is ordinarily the holder of the privilege unless the patient has a guardian or conservator, in which case the holder of the privilege is the guardian or conservator.
Answer B is incorrect: A therapist can claim or assert the privilege on behalf of a patient but is not the holder of the privilege.
Answer C is incorrect: Case law has confirmed that minors are the holder of the privilege in California, even though they may rely on adults to claim or waive the privilege on their behalf.
Answer D is incorrect: A judge may rule on whether or not client information is privileged, but the judge is not the holder of the privilege.
The correct answer is: The patient’s guardian or conservator.
Mr. Morris contacts his son’s school requesting that he be allowed to review his son’s school records. The son has been treated for ADHD and is in a special program at the school designed to decrease the stimulation such students encounter in the setting and increase their success. It turns out that Mr. Morris is not the custodial parent and that his son has been living with Mrs. Morris for over two years. California law provides that:
Select one:
A.
the boy’s records should be released only to the custodial parent.
B.
the boy’s records cannot be released to the non-custodial parent without the written permission of the custodial parent.
C.
non-custodial parents cannot be denied access to their children’s records.
D.
release of the records is up to the discretion of appropriate school officials.
Answer C is correct: Family Code Section 3025 applies to this situation. It states: “Notwithstanding any other provision of law, access to records and information pertaining to a minor child, including, but not limited to medical, dental, and school records, shall not be denied to a parent because such parent is not the child’s custodial parent.” You may have been concerned that the question does not indicate the son’s age; however, the question is concerned with custody issues, which suggests that the son is a minor.
The correct answer is: non-custodial parents cannot be denied access to their children’s records.
You are a newly licensed MFT and are considering turning one of the bedrooms in your home into a therapy office. There is no problem with this arrangement, and it is considered safe and appropriate when:
Select one:
A.
you are mindful of the types of clients who may not be appropriately contained in this environment.
B.
you intend to move to a different office when it is financially feasible to do so.
C.
you have low fees that reflect your low costs.
D.
your theoretical orientation allows it.
Answer A is correct: The use of one’s home as a place to conduct therapy is not addressed by legal or ethical guidelines, so a good rule of thumb is to use sound clinical judgment and remain sensitive to the transference and boundary issues that might arise. This answer is most consistent with being alert to the possibility that some clients (e.g., those with attachment problems) may develop strong transference feelings when being seen in the therapist’s home.
Answer B is incorrect: This suggests that the only reason a therapist should have an office in his or her home is if he or she cannot afford to pay for office space elsewhere. That is not true.
Answer C is incorrect: One’s office space, whether it is in one’s home or elsewhere, may or may not affect one’s fees. Generally, you simply want your fees to be competitive and must make sure that they are fair to your clients.
Answer D is incorrect: It’s hard to think of a theoretical orientation that would specifically disallow a therapist to have a home office. Regardless of a therapist’s approach to therapy, he or she would need to make sure that his or her office space is appropriate for the purpose of providing therapy and that he or she considers the needs of each client.
The correct answer is: you are mindful of the types of clients who may not be appropriately contained in this environment.
A divorced mother brings her daughter for therapy. The daughter has had “emotional problems” according to the mother, including breaking down sobbing whenever she doesn’t get her way. The mother was in jail when her divorce became final, and she says she isn’t sure of the formal custody arrangements. She hasn’t seen the child’s father since she was released from jail. With regard to seeing the daughter in therapy, you:
Select one:
A.
should ask the mother to bring in a copy of the court’s ruling to determine who can give consent to treatment.
B.
can provide treatment with only the daughter’s consent as long as she is at least 12 years of age.
C.
see the daughter in therapy only if you get consent from both the mother and father.
D.
can see the mother and daughter together because the father’s consent is not needed for family therapy.
Answer A is correct: Asking the mother to see a copy of the ruling regarding the divorce and custody agreement and keeping a copy in your files is the best way to handle the matter of consent to treat a minor. In California, joint physical and legal custody is the norm. However, often divorce attorneys stipulate that both parents need to consent for medical and mental health treatment.
Answer B is incorrect: This may not be true. There is insufficient information about the daughter to determine if she would meet the legal requirements for seeing her in therapy without the consent of a parent.
Answers C & D are incorrect: These statements may not be true. To find out whose consent you need to treat the daughter, you would need to see the court ruling.
The correct answer is: should ask the mother to bring in a copy of the court’s ruling to determine who can give consent to treatment.
You receive a call from a woman who says she has been in therapy with another therapist who let her pay for treatment by doing office work for him. She says she would like to start seeing you now and asks if you could make the same fee arrangement. You should:
Select one:
A.
report the therapist to the BBS.
B.
schedule an appointment with the woman and defer the discussion of fees until the first session.
C.
advise the woman, over the phone, of the ethical problems associated with bartering.
D.
encourage the woman to continue her existing arrangement with the other therapist since it seems to suit her financial situation.
Answer C is correct: This question presents two problematic issues – the client is currently in therapy with another therapist and the therapist lets her “pay” for therapy by working for him. The answer options suggest that the latter is the focus of the question, and this answer is most consistent with ethical guidelines. Barter is addressed in Principle 9.5 of the CAMFT Code of Ethics. It states that MFTs “ordinarily refrain from accepting goods, services, or other non-monetary remuneration from patients in return for professional services” because these arrangements can lead to conflicts and exploitation. This suggests that barter is not completely prohibited; however, before accepting a bartering arrangement, you would want to consider the consequences of doing so as well as alternatives to bartering.
Answer A is incorrect: You are not obligated to report the other therapist to the BBS.
Answer B is incorrect: Establishing a fee is typically done during the initial phone call. Also, you would want to address the woman’s request to exchange office work for therapy before agreeing to see her in therapy.
Answer D is incorrect: Encouraging the woman to continue her existing arrangement would be inappropriate for several reasons including the fact that, by doing so, you’d be endorsing the woman’s financial arrangement with the other therapist.
The correct answer is: advise the woman, over the phone, of the ethical problems associated with bartering.
A six-year-old girl says a 18-year-old neighbor asked her to pull down her pants and show him her buttocks. She says she did not do it and just ran away. The girl does not seem particularly upset by the incident. The therapist should:
Select one:
A.
call the county welfare department or the police immediately.
B.
investigate further.
C.
reassure the parents and child that no damage was done and move on in therapy.
D.
see the girl in an individual play therapy session to explore the possibility of sexual abuse.
Answer A is correct: This activity probably qualifies as child molestation, even though the child was not touched. Consequently, it arouses a reasonable suspicion of child abuse and requires a report.
Answers B & D are incorrect: They both suggest further assessment, which is a good idea, but there is at least a reasonable suspicion that child sexual abuse has occurred, so a report is mandated.
The correct answer is: call the county welfare department or the police immediately.
During his first therapy session, your new client tells you that his insurance covers only ten sessions and that he cannot afford your fee. He has a long history of relationship problems and has never been able to stay with a partner for more than a couple of months. Based on what he tells you, you conclude that the client probably needs long-term therapy. What should you do?
Select one:
A.
Reduce the client’s fee after the ten sessions.
B.
Contact the insurance company and insist that it cover the necessary sessions.
C.
See the client for ten sessions, intervene on behalf of the client with the insurance company, and then refer to a low-cost clinic if the company declines to cover your fee.
D.
Refer the client to a low fee clinic.
Answer D is correct: This would be in the best interests of the client. If the client needs long-term therapy, it would be better to have him begin with the therapist who will be able to see him long-term.
Answer A is incorrect: Reducing the client’s fee is an option, but fee reduction is not a legal or ethical requirement.
Answer B is incorrect: This is not the best answer since the word “insist” is too strong. In addition, it doesn’t address the possibility that the insurance company will continue to refuse to cover additional sessions.
Answer C is incorrect: This is not the best answer because referring the client to another provider after ten sessions would not be in the client’s best interests.
The correct answer is: Refer the client to a low fee clinic.
You are an MFT working in a college counseling center. Your new client, Kathy, begins seeing you to help her manage her depression and tells you that she has gained a lot of weight, and cries all the time. Kathy admits suicidal ideation but says that she does not have a plan. She states, “My roommate is really stressing me out too. She has this creepy boyfriend who is always hanging out in our room, and I never have any privacy. One day you get a call from a woman who claims to be Kathy’s friend. She states, “Kathy seems to have really gone over the edge. She says she has had enough of her roommate and her loser boyfriend and has bought a knife that she is going to use on them.” What are your legal obligations in this case?
Select one:
A.
Call the police and alert the roommate and her boyfriend immediately.
B.
Do not breach Kathy’s confidentiality.
C.
Contact Kathy’s parents.
D.
Call the roommate and boyfriend and alert them to this threat.
Answer B is correct: This is a difficult question because it involves a threat of imminent danger to others and the therapist would be inclined to protect the intended victim or victims. However, while the court has expanded the Tarasoff duty to protect, the expanded duty applies to credible threats received from the client’s family. A warning from the client’s friend would not be considered a legal reason to break confidentiality with your client.
The correct answer is: Do not breach Kathy’s confidentiality.
If a therapist dies, it is LEAST likely that his records will be:
Select one:
A.
given to the clients.
B.
given to a lawyer designated by the family to deal with the therapist’s personal effects.
C.
distributed according to the therapist’s will or given to the therapist’s spouse or executor.
D.
given to the agency where the therapist worked.
Answer A is correct: A therapist should make arrangements for what will happen to his or her client records in the event of his or her death. The records are least likely to be given to the clients since it might not be in a client’s best interest to see all of his or her records. In addition, although the content of the therapist’s records belongs to the clients, the physical records do not. The options listed in the other answers are possibilities.
The correct answer is: given to the clients.
Another therapist calls you to request information about a client of yours who is now seeing him. He says “the authorization is in the mail.” The client abruptly stopped showing up to sessions with you three weeks ago. You should:
Select one:
A.
not even acknowledge that the person is a client.
B.
tell the therapist you’ll send the information as soon as you receive the authorization.
C.
tell the therapist that the client needs to formally terminate with you first.
D.
send the requested info
Answer A is correct: Unless you are legally or ethically required to do otherwise, you should maintain the confidentiality of current and former clients. In the situation described in this question, you would not want to reveal confidential information to the therapist, including acknowledging that the person is (or was) your client. Answer B is not the best answer because it confirms that the person is your client.
The correct answer is: not even acknowledge that the person is a client.
A client you have been seeing for several months suddenly tells you that she can no longer afford to see you. She says she has to end therapy but does not want to. You:
Select one:
A.
tell her you cannot see her for free but will refer her to a low fee clinic.
B.
tell her you will lower your fee for now and bill her for the difference when she can pay.
C.
respect her decision to terminate and invite her to come back when she can afford your fee.
D.
lower your fee and have her agree to increasing the fee when her financial situation improves.
Answer D is correct: You are not ethically required to lower your fee for a client who cannot pay your full fee. However, of the answers given this is the best one. When taking the exam, keep in mind that the optimal answer may not be given and, for those questions, you’ll have to choose the “best” one.
Answer A is incorrect: The word “cannot” in this answer suggests that it would be unethical or illegal to see a client for free, which it isn’t. This could be your policy, but don’t expect exam questions to cover all the unique policies of individual MFT. When answering questions on ethical issues, look for answers that apply generally to the profession.
Answer B is incorrect: This is not the best answer because allowing your client to accrue a large unpaid balance would not be in her best interests.
Answer C is incorrect: The client prefers to stay in therapy, so terminating therapy at this time may not be in her best interests. In addition, terminating therapy without providing her with referrals would constitute abandonment.
The correct answer is: lower your fee and have her agree to increasing the fee when her financial situation improves.
You have been working with Albert for nearly six months. He has received a diagnosis of major depressive disorder and, during the course of therapy, you have given him several referrals that you believe are important for his treatment progress, including a referral to a psychiatrist for a medication evaluation. However, Albert has refused to follow-up on any of your referrals. In this situation, it is your responsibility to:
Select one:
A.
end treatment immediately.
B.
end treatment if Albert agrees that he is not making any progress.
C.
continue treatment but process the meaning of Albert’s refusal to follow-up on your referrals.
D.
continue treatment and realize that it’s up to Albert to decide if he wants to follow-up on your referrals.
Answer C is correct: An MFT in this situation would be expected to assess, evaluate, and process the meaning of the client’s resistance, regardless of his or her theoretical orientation.
Answer A is incorrect: Abandoning the client is not a solution to the problem described in this question. You would not be acting in the client’s best interest if you terminated therapy.
Answer B is incorrect: MFTs should not continue providing therapy to clients who are not benefiting from it, but this is not the best answer because it does not address the issue presented in the question. Also, a client who is depressed may not be able to objectively evaluate his progress in therapy.
Answer D is incorrect: Although it is Albert’s decision whether or not to follow-up on your referrals, you would want to discuss this with him.
The correct answer is: continue treatment but process the meaning of Albert’s refusal to follow-up on your referrals.
Your client is a single mother of two children. She is having difficulty paying her rent every month and, in fact, is a few months behind. After three months of therapy, she tells you that her insurance has run out and that she’s going to have to terminate therapy with you because she can’t afford to pay your fee. She tells you that she feels she can trust you, that therapy is helping, and that she would rather not stop coming to see you. You should:
Select one:
A.
give her a number of appropriate and affordable referrals in her area.
B.
ask her what she has to barter for therapy.
C.
suggest she look for a free clinic.
D.
encourage her to see this break in therapy as a positive thing and request that she come back when her insurance is reinstated.
Answer A is correct: When a client cannot afford to pay for treatment, a therapist has several options. In a situation like this one, the best option would probably be to continue treatment at a reduced fee the client can afford. Unfortunately, this isn’t one of the options given in the answers. Of the options, giving the client appropriate referrals is the best choice. If you are unable to continue treatment because a client can no longer afford your fee and lowering your fee to an amount the client can afford is not an option, the most appropriate course of action is to provide the client with appropriate and affordable referrals.
Answer B is incorrect: It would not be clinically appropriate or ethical to ask the client to barter for therapy.
Answer C is incorrect: If a therapist has to terminate treatment because the client can no longer afford it, it is imperative that he or she provide the client with appropriate referrals. Anything less would constitute abandonment of the client.
Answer D is incorrect: This option is dishonest and unethical. You would not want to mislead a client in this way.
The correct answer is: give her a number of appropriate and affordable referrals in her area.
A psychologist who works at the mental health clinic where you work tells you he’s heard that Bob Bronstein, one of your current clients, has threatened to harm someone. The psychologist is not willing to reveal the source of his information but says he believes the information is valid. You have been working with Bob for several months and believe he’s capable of becoming physically violent toward someone when sufficiently provoked. You should:
Select one:
A.
contact the police.
B.
question Bob in a general way during his next therapy session to determine if he’s angry at anyone.
C.
discuss this information with Bob during his next therapy session.
D.
call Bob’s wife to determine if she has any concerns about her husband’s current potential for violent behavior.
Answer C is correct: When a client communicates a serious threat of physical harm to a reasonably identifiable victim, you have a duty to protect the intended victim by notifying the victim, contacting the police, or taking whatever other steps are necessary. However, in the situation described in this question, the information has come from an anonymous source, and you have no information about the intended victim or about Bob’s degree of dangerousness. Therefore, the best course of action would be to discuss what you learned with Bob to determine if he poses a serious threat of physical harm to anyone.
The correct answer is: discuss this information with Bob during his next therapy session.
