Midterm Flashcards
Bella v Greenson
TH must take reasonable steps to prevent SI
Do we report historical crimes if that crime was committed against an adult? (from an unprotected class?)
No. Only protected classes / minors
How many years need to pass if TH wants a sexual / romantic relationship with a previous CT?
Legally, 2 years. Ethically, still always unsound
Scope of Practice vs Scope of Competence
Practice: License, doesn’t expand
Competence: Experience / CE, can expand
Tarasoff criteria
1 - Threat was made by CT or credible 3rd party
2 - Of imminent, grave harm
3 - To reasonably identified victims
Define + examples of Standard of Care
Definition: The degree of care that’s offered between most professionals within a specific scope
Examples: Providing diagnosis, collecting family / personal / medical history, performing assessments, providing fee information up front, informed consent forms, reasonable steps to prevent SI, etc
How do you perform a formal assessment of violence?
1 - Psychotherapy checklist
2 - Violence Risk Appraisal guide
3 - Violent Offenders: Appraising and managing Risk.
Assessing Violence Risk (ACTION)
A = Attitude supporting or facilitating violence
C = Capacity to commit the violence
T= Threshold crossed ( planning)
I = Intent ( impaired thinking)
O = Other reactions ( hoping for a race war)
N = Noncompliance with risk reduction measures ( going off meds, combining meds with alcohol, not going to anger management)
Definition of Privilege
Protects confidentiality between TH and CT. It’s established after they enter into a “special relationship”
What happens to privilege if the CT threatens the TH?
They are no longer in a “special relationship,” and privilege is therefore revoked
What steps should a TH take to manage countertransference? (J, P/S, TH, R)
- Journal
- Discuss issue with peers / supervisor. Get consultation.
- Talk to own TH
- Last resort: refer CT out if unable to be objective / best interest of client / client-focused
What is the TH’s job regarding SI or HI?
Assess for means and a plan
Example of TH breaching CT confidentiality
Thanking referral source without the CT permission
Who can revoke a TH license?
BBS
Law vs Ethics
Law: What you should or should not do
Ethics: What is right or good
Is a subpoena an order to release information?
No
How many hours do you have to call PD in a Tarasoff case?
24 hours
If the CT has chosen to waive privilege, what do you do next?
Obtain a written waiver from CT and add it to their records. Then comply
How do you assess / manage DV in session?
- Assess: one partner always looking down or speaking softly, deferring to other partner. Visable bruising or other signs of violence.
- Manage: Separate the couples and ask possible victim (when abuser is not present) if there’s DV. Educate on cycle of abuse, offer resources. (Ask abuser other questions.)
- Decline to work with them unless for individual counseling and say it’s not a good time / not a good fit for right now. Be vague.
- Do not report.
Who decides to waive privilege?
CT
Problems re: Countertransference?
- Premature termination
- Inappropriate behavior from TH
- Harmful attitudes/behaviors toward CT
- Lack of TH insight / marginalizing CT
- Failure to meet therapeutic needs of CT
What do you document in a Tarasoff case?
- Concerns
- History
- MSE
- Interventions used or suggested, and reasons why
- CT rxn to those interventions
- PD badge number
- Certified letter to PD + intended victim re concerns and notifying action taken / when
Who do you need to contact in Tarasoff case when a CT says “I’m going to blow up a building”?
Contact building manager and whoever is in charge because other units / property / people can be impacted
Who’s likely re SI?
WHO:
1. Men, 70+ most complete. Women attempts. Teens high risk.
2. MDD. With recurrent or psychotic specifiers highest rate
3. Prior hx
4. Plans, means, attempt
5. Sickness (self or loved one)
Evidence Code 1024
TH able to break confidentiality to protect CT or person or property
- IF mental/emotional condition
- OR if CT is gravely disabled
What steps do you take if your CT is SI?
ASSESS for Means / Plan
1. Ask direct questions
2. MSE
3. Does CT need higher level of care?
MANAGE
1. Document
2. How serious / imminent
3. 51/50? Call family member?
4. Reach out to MD
5. Post care management to extend safety net after initial crisis is mitigated
Signs or cues that signal SI
SIGNS
1. Giving away belongings or pets
2. Depression lifted after meds, now has energy to complete
3. “I’ve found the answer” “I need relief” “Don’t need therapy anymore”
4. Writing a will at inappropriate age
Gross v Allen (definition / how to apply)
Duty to Inform
Must tell other providers about CT SI hx
Who do you need to have sign the release forms when you’re treating a family unit, and someone decides to sue someone else?
Everyone
Legal and Ethical re Confidentiality
Legal: must be maintained unless legally mandated to break it
Ethical: CTs should be informed of limitations from the start (don’t tell me about something you don’t want me to share.. these things etc)
How do you respond to a CT client who is SI, if you’re a Trainee?
You are still required to assess and manage
Define gravely disabled
Unable to function
What’s the best legal defense?
Documentation
Is hospitalization required for SI fantasy?
No
Bella vs Greenson
Reasonable steps to prevent SI
Re: SI or HI, what’s the TH job?
Assess then manage
Legally, can TH talk to other MH providers re diagnoses?
Legally, yes! Ethically, meh
Best way to work through countertransference?
Own therapy
Are dupe services allowed in CA?
No
When do you refer a CT out when you’re experiencing unmanaged countertransference?
When client care is no longer CT centered
Age to be a life coach
18
Do you ask indirect or direct questions when assessing for SI?
Direct
Are TH encouraged to write emo support letters for CTs?
No
If TH ends up with DUI, how long do you have to be sober before going back to work?
30 days
What is confidential?
Everything except what’s mandated by law
No secrets policy?
Couples counseling, can’t hear a secret from one partner kept from the other. Must be agreed to ahead of time
CT that’s 51/50, do they have the right to know where they’re going?
yes!
If CT commits crime against minor in past, do you report?
YES
If CT threatens to harm self, others, property, or is gravely disabled, can they be 51/50d?
Yes
