Oral Exam Flashcards
Diagnosis
Proper Diagnosis - take careful consideration to ensure proper diagnosis, including the appropriate selection & use of assessments & treatment options. Base diagnoses on multiple sources of data when possible. Only use assessments we are trained to use.
Cultural sensitivity – consider how multicultural & socioeconomic factors may affect the diagnosis process, including how problems are defined, interpretation of assessments, & treatment recommendations.
Prejudice & Bias - strive to become aware of & recognize how historical & personal prejudices & biases may result in misdiagnosing & pathologizing the client.
Risks & Benefits – consider positive & negative implications; refrain from making a diagnosis if it will cause harm.
Release of report - do not release unless there is a court order.
Cultural diversity
Honor diversity - honor diversity & embrace a multicultural approach in support of the worth, dignity, potential & uniqueness of people within social & cultural context
Cultural considerations – take cultural considerations into account in essentially every aspect related to our counseling.
Multicultural Competence - we make the effort to become multiculturally competent by educating ourselves & seeking extra training through continuing education. Strive to become aware of a client’s cultural background, including norms and beliefs.
Aware of Biases - aware of and educate themselves on their own biases. Seek consultation, supervision, or counseling to prevent biases from interfering.
Communicate clearly in understandable language and culturally appropriate ways, especially when discussing informed consent. Provide an interpreter when necessary to ensure comprehension.
Values
Own values – aware of our own values, attitudes & beliefs, & avoid imposing them on clients. We have a responsibility to educate ourselves about our own biases regarding different races, creeds, orientations, cultures, & physical & mental abilities. Do not engage in sexual harassment.
Non-discrimination & self-education – do not discriminate based on ability, age, culture, ethnicity, sex, gender identity, race, religion, national origin, political beliefs, sexual orientation, relationship status, or socioeconomic status.
Seek consultation, supervision & training – seek supervision & consultation to prevent biases from interfering. Seek training in areas they are at risk of imposing values on clients.
Client Autonomy & self-determination – counselors ensure client autonomy and self -determination, and the right to make informed choices (except for cases where there is imminent harm to self or others). Do not condone or engage in conversion therapy. Must respect the values of clients & have the ability to work with a wide range of clients with diverse values & backgrounds.
Termination & Referral – cannot terminate or refer based solely on values difference.
Advocacy
Counselors as advocates – counselors are encouraged to advocate for individual, group, institutional, and sociopolitical change to improve the welfare of their clients and community. Also encourage clients to advocate for themselves.
Avoid pitfalls & conflicts of interest - Remain sensitive to personal and cultural impact advocacy may have on clients. Avoid conflicts of interest & dual relationships. Aware of potential dangers of becoming overly involved.
Speak on your own behalf, factually, and clearly distinguish between facts and opinions.
Client consent – obtain client consent prior to engaging in advocacy efforts on behalf of an identifiable client.
Client rights
Multicultural considerations – have awareness of different cultural meanings of confidentiality, and different views toward disclosure of information.
Respect privacy & confidentiality – respect privacy of clients. Only request private info when it is beneficial to the counseling process. Protect confidential info of clients. Only disclose with appropriate consent or legal or ethical justification.
Explain limits to confidentiality – done at beginning of therapy & is an ongoing process. Limits: serious & foreseeable harm to self or others, contagious life-threatening diseases, court ordered disclosure, end of life (depending on laws).
Clients’ rights
o Treated with dignity, consideration, & respect.
o Quality services by trained & competent staff.
o Confidentiality, & informed of limits to confidentiality
o Informed of therapy process, goals, CMHC’s education & credentials, fees, termination procedures, use of collections.
o Knowledge & participation in treatment plan
o Right to client records, and progress info.
o Refuse services
o Safe environment
o Clearly defined termination procedure & right to terminate at any time
Ethical Decision Making Model
We must use some form of an ethical decision making model and must document that we did so!
The model must include ethical codes/standards, principles, and laws; a plan of action; risks and benefits; and an objective decision based on the circumstances and welfare of all involved. (Think culture, justice and universality)
In our particular model we: identify the problem and our reactions. Examine the codes, laws and literature. Consult with colleagues, supervisors or experts and document that consultation. Design the action plan. Evaluate it. Document!
Group Counseling
Clarify who is the client! (The ‘family’ or the ‘relationship’) If there are conflicting roles we may adjust or withdraw.
We make it clear that everyone involved has rights to confidentiality and we explain the limits within a group setting.
We will not change roles from treating the group, couple, or family and shift into individual counseling.
Family Counseling
Go through a process of screening those that will be in the group and make sure that their needs and goals are compatible and will not hurt the group.
We will work to protect those in the group from harm. (Physical, emotional, psychological)
Explain that confidentiality extends to all members but has its limitations.
We must remain objective and if we see conflicting roles we must adjust or withdraw.
Technology Supported Counseling
Technology in counseling includes ANYTHING that can be plugged in! (Actual electronic counseling as well as any tech used for arranging, coordinating, paying, record storage, etc.)
It is recommended that we use an electronic health record (EHR) in order to keep everything secure and in one place. All communication should be encrypted.
Control access to your computer and have multiple locks. (For example your computer should be locked away and there should also be locks/passwords protecting any information/identity)
If you are counseling a client in a different state you need to be within the grace period for that state or obtain permission from the state. Be familiar with that state’s laws and be prepared to aid your client if they will be needing emergency care in that state. (Hopital info, emergency care, etc.)
Professional and personal social media must be kept separate and anything personal should be private.
Only seek out information on your client if: you’ve been specifically directed by the client, for a specific time and for a therapeutic/forensic purpose, and with permission/documentation OR if you are concerned about safety.
Only provide tech counseling if it can be done in “real time”.
Conduct a “fit for technology” screening before doing distance counseling
Duty to Report
Do not honor the client’s legal/ethical right to confidentiality when
-You have reason to believe they might harm themselves or someone else, the latter of which includes communicable diseases.
-You have reason to suspect child abuse, elderly abuse or abuse of a protected/vulnerable adult.
- You have a court order.
Documentation when you break confidentiality:
- Use direct quotes from the client, if possible.
- Fully describe the assessment or process that led to the confidentiality breach.
- Explain your rationale.
- Note all consultations and supervision meetings related to the issue.
Investigation is not in your scope of practice.
Contact the Risk-Management consultation service provided by your malpractice insurance.
Bartering
Only ethical if the bartering does not result in exploitation or harm, if the client requests it, and if such arrangements are an accepted practice among professionals in the community.
Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract.
Consult and document
Competence
Recognize the boundaries of your competence and stay within the area of your expertise.
Only provide services and take jobs you are qualified for.
Counselors use only those testing and assessment services for which they have been trained and are competent.
Continually striving to become more competent including multicultural competence.
Be aware of any personal impairment (physical, emotional, mental) and seek assistance or withdrawl from counseling if needed.
During each two year period commencing October 1st of each even numbered year, a clinical mental health counselor or licensed associate clinical mental health counselor shall complete at least 40 hours of continuing education directly related to the licensee’s professional practice of which at least six hours shall be in ethics/law.
You should only refer when issues are outside of your boundary of competence or when your case load is full.
You should refer to a therapist you have vetted, is taking new clients, and that you can provide the contact information for. It is best practice to do a 3 person call with the person’s new therapist.
Gate keeping
Faculty should
Select students with adherence to selection criteria that screen for competence to be a student
Provide opportunities to learn essential skills required for competent practice
Provide formative and summative feedback
Graduate those students who are capable of providing competent care (Gatekeeping)
It is a program’s legal and ethical obligation to protect consumers by identifying and intervening with graduate students who exhibit problematic behaviors or performance problems that do not respond to appropriate remediation
When programs dismiss students they must show due process:
adherence to appropriate and standardized protocols that include:
Standardized formative and summative feedback on
Academic performance
Counseling Skills
Intra and interpersonal characteristics
Professional behaviors
Appropriate and fair remediation protocols for students who have issues with any of the above.
Supervision
Written informed consent before beginning relationship between supervisor and supervisee
There is a distinction between administrative supervision and clinical supervision
There is 1.5 years of supervision in the program and at least 2 years (or 3000 hours) after the program
When you are supervised you are practicing under someone else’s license
Supervisee Best Practices Include: come to supervision prepared, Discuss your relationship with your supervisor, discuss your strengths, growth edges, and goals, and all supervision sessions are mandatory
Can not supervise those who they can’t remain objective with (friends, family, etc.)
Supervisor is protecting the client’s welfare, while also helping the professional development of the supervisee
Supervisee informs client of the limits of confidentiality pertaining to supervision
Maintain professional relationship with supervisee
Do not have sex, sexually harass supervisees, or exploitation
Gatekeeping responsibility
Ethical Business Practice (Marketing, Billing, Fees)
It should be clearly laid out the expectations and responsibilities of both counselor and client in the counseling process
Counselors provide counselor credentials, issues of confidentiality, the use of tests and inventories, diagnosis, reports, billing, and therapeutic process to clients
Counselor talk with client about time of sessions, payment plans/fees, absences, access, emergency procedures, third-party reimbursement procedures, termination and referral procedures, and advanced notice of the use of collection agencies
Mental health counselors are cognizant of cultural norms in relation to fee arrangements, bartering, and gifts. Bartering cannot include exploitation or harm
Counselors provide pro bono services and work with some clients on a sliding scale
Any marketing/website information needs to be factual and honest, and accessible to diverse cultural groups
Can terminate services if client doesn’t pay fees or if insurance denies treatment
Avoid self-referral- when working in an organization that provides counseling, do not refer clients to your private practice or other place of employment
Do not engage in fee splitting, commission, rebates when referring
Honest and accurate in reporting to third parties, such as insurance
