One last one Flashcards
An LCSW has been conducting telehealth sessions via video with a 23-year-old client. In the middle of a session, the client’s boyfriend walks into the frame, is visible to the therapist, kisses the client, and appears to leave their home to go to work. The LCSW should:
A Discuss the risks to confidentiality when working online
B Ask the client to sign a Release of Information form allowing disclosure of therapeutic information, even if incidental, to the partner
C Ask the partner to sign a Release of Information form allowing them to receive information
D Discontinue the session and, in writing, remind the client that therapy is to be conducted only from a private, confidential setting. If the client cannot find such a setting, they are inappropriate for telehealth
A Discuss the risks to confidentiality when working online
It is ultimately the responsibility of the client, and not the therapist, to control confidentiality at the client’s end during technology-based sessions. In this instance, because any disclosure of information is being caused by the client and not the LCSW, a Release of Information is not necessary, either from the client (B) or the partner (C). An LCSW does, however, have an ethical obligation to remind clients of the limits of confidentiality where appropriate, as well as a responsibility to discuss with clients the risks associated with technology-based work. While suddenly discontinuing the session (D) would be an overreaction – the partner is now gone, so there is no immediate risk of additional disclosures – it would be appropriate for the LCSW to discuss the risks to confidentiality when working online (A).
In preparation for a move to a new city, an LCSW is selling her home. The LCSW’s real estate agent shows the home to prospective buyers. In discussing one prospective buyer, the LCSW comes to realize that the individual is a current client. The LCSW’s photos and personal effects have been removed from the home, but if the sale were to move forward with the client, the client would ultimately learn that they were buying the LCSW’s home. What should the LCSW do?
A Terminate therapy with the client, as this would become necessary with the pending move anyway and allows the client to participate in the home buying process as they see fit
B Consider whether the client is an appropriate buyer for the home, considering their symptoms, their socioeconomic status, and the neighborhood the home is in
C Seek consultation
D Without revealing that the prospective buyer is a client, give the real estate agent guidance on how to most effectively communicate with that buyer, based on the LCSW’s knowledge of them
C Seek consultation
After years of providing services in the office, an LCSW decides to transition their practice to be exclusively online. The LCSW selects a new videoconferencing platform that advertises itself as being secure and HIPAA-compliant. In a letter, the LCSW informs all existing office clients that their care will be moved online as of roughly one month from the date of the letter. Prior to completing this transition, what must the LCSW do to address their ethical responsibilities?
A Terminate or refer out all in-person clients with serious symptoms
B Allow the clients to choose whether they would like to continue seeing the LCSW in-office rather than moving to telehealth
C Take reasonable steps to identify crisis resources local to each client
D Ensure they are adequately trained on using the videoconference software
D Ensure they are adequately trained on using the videoconference software
While not every client can be successfully treated via telehealth, there is no ethical or legal obligation to refer out on the basis of “serious symptoms” (A). Instead, the obligation is to assess whether each client is appropriate for telehealth. Some clients with serious symptoms (such as serious depression or agoraphobia) might even be particularly well-suited to telehealth. The LCSW is not obligated to honor client preferences about in-person care (B); such an obligation would mean that a client could bind a therapist to their physical office for months or even years beyond when the therapist would want to leave that office. Identifying crisis resources (C) is a legal obligation, not an ethical one. Ethically, the
An LCSW has been working with a couple for four months when the couple decides to separate. They ask the LCSW whether they can continue as individual clients in order to address the impacts of the separation on each of them individually and on their family (the couple shares a two-year-old daughter). They report that they have not finalized a decision on whether to divorce but have no interest in working on their relationship at this time. Which of the following is the best course of action, considering the LCSW’s ethical responsibilities?
A Discuss with each partner that the LCSW can become the individual therapist to one, but not both, of them in order to minimize potential conflicts
B Given the potential for conflicts emerging from individual care, refer each partner to other providers for individual work, and let them know that the LCSW would be happy to work with them together in the future on relationship or co-parenting issues
C Agree to continue as the individual therapist for both partners only if they both agree to a “no secrets” policy that allows the LCSW to share information between them so as to avoid getting caught up in conflict
D Agree to continue as the therapist for both partners only if they agree that they will not discuss each other during their individual work, and new files and treatment plans will be created
B Given the potential for conflicts emerging from individual care, refer each partner to other providers for individual work, and let them know that the LCSW would be happy to work with them together in the future on relationship or co-parenting issues
A family is in therapy seeking help with parenting conflict. They report that the teenage daughter is frequently defiant at home, and the parents cannot agree on a strategy for controlling her behavior. The parents ask the LCSW to provide a superbill that they can submit to their insurance carrier for possible reimbursement. The LCSW provides the superbill, but the insurance provider refuses payment because the superbill was submitted without a diagnosis code. The LCSW should:
A Develop a diagnosis of the primary insurance holder and resubmit the superbill
B Complain to the state Department of Managed Health Care
C Remind the clients about the limitations of coverage
D Appeal the denial of payment, citing parity law
C Remind the clients about the limitations of coverage
A client’s doctor has prescribed the client medication to help treat the client’s obsessive-compulsive disorder. In therapy, the client reports that the medication has helped them reduce instances of compulsive behavior, but they find themselves continuing to struggle with patterns of obsessive thought. The client reports some difficulty with taking their medication at the same time every day, as the doctor prescribed. The therapist should:
A Encourage compliance with the prescribed medication treatment, and work with the client on ways of managing current symptoms and taking their medication on time
B Avoid any discussion about the medication or its effects, and focus on symptom reduction
C Encourage the client to consider minor adjustments in medication dosage
D Refer the client back to their physician to discuss symptoms and medication compliance
A Encourage compliance with the prescribed medication treatment, and work with the client on ways of managing current symptoms and taking their medication on time
An LCSW in a prison mental health setting learns that a client who had been convicted of intimate partner violence was reluctant to attend therapy because a prior therapist had offered the client sex if the client was willing to break up with his wife. The client had refused to do so, and the therapist had then explained that she did not think the client’s relationship was healthy. The client now tells the LCSW that the prior therapist was right, but he still felt unsure about therapists as a result of the prior experience. What should the LCSW do next?
A Educate the client about proper therapeutic boundaries
B Ask for a Release of Information to speak to the prior therapist
C Educate the client about the apparent purpose behind the prior therapist’s intervention while being careful to clarify that it was not appropriate
D Provide the client with the brochure Therapy Never Includes Sexual Behavior
D Provide the client with the brochure Therapy Never Includes Sexual Behavior
An LCSW is treating an adolescent client who was mandated to therapy by the juvenile court system following a series of convictions for shoplifting, truancy, and other low-level offenses. The LCSW has been treating the adolescent for six sessions with moderate progress when the client provides the LCSW with a form from the court that the LCSW is supposed to complete in order to evaluate the client’s participation and progress in therapy. The form specifically asks the LCSW to evaluate the client’s preparedness to be released from probation. The form says it is to be returned by the LCSW to the juvenile probation office. The LCSW should:
A Decline to complete the form
B Complete the form and return it to the client to submit to the juvenile probation office
C Complete the form and return it to the juvenile probation office as instructed
D Complete those sections of the form that relate to dates of service and topics of therapy, while leaving evaluative questions blank except to clarify that the LCSW cannot answer those questions
D Complete those sections of the form that relate to dates of service and topics of therapy, while leaving evaluative questions blank except to clarify that the LCSW cannot answer those questions
The LCSW is right to be careful about the distinction between a treating therapist and an evaluator. Our ethics demand that we keep those roles separate. However, communication with the probation office is allowed so long as the LCSW remains in the treating therapist role. The LCSW could safely complete information about dates of service and topics of therapy without serving as an evaluator for probation purposes.
