PSYC 514- Ethics

Question 1

Assent v. consent to treatment

Answer 1

In clinical practice, individuals who have reached the legal age of consent (18 in the US) consent to treatment. People who cannot legally consent to treatment can assent to treatment when it is explained at their developmental level. Work with children or adults not capable of giving consent requires the consent of the parent or legal guardian and the assent of the subject.

Clinical example: 16 year old Jenny’s mom brings her to treatment for substance abuse concerns. The therapist discusses the informed consent document with Jenny and her mom, and her mom signs it. The therapist uses language that Jenny understands about the process of therapy and asks Jenny if she is willing to engage in the process. She says yes. Jenny’s mom has provided consent on her behalf, and Jenny has given assent.

Question 2

Confidentiality

Answer 2

The primary responsibility of an ethical practictioner, confidentiality is an obligation to keep information discussed in counseling private. There are three exceptions to confidentiality explained to clients during the informed consent process. They include duty to warn in cases in which the therapist anticipates harm to the client or another individual, mandated reporting of abuse to children, the elderly, and disabled persons, or if court-ordered. Clinical

Example: A therapist learns her patient, a child, is being sexually abused by her father and breaks confidentiality by reporting this to the police.

Question 3

Counselor competency

Answer 3

Part of ethical practice, counselor competency refers to the idea that a counselor is qualified to practice with the patient or population in question. Competence is determined by their education, training, supervised experience, credentials and professional experience. Counselors maintain competence through continuing education of current scientific and professional information in their fields.

Example: A counselor assesses a patient she hypothesizes has Borderline Personality Disorder. The counselor does not feel competent to effectively treat the patient and refers them to a colleague that is trained in DBT.

Question 4

Dual/multiple relationships

Answer 4

Dual relationships are when multiple roles exist between a therapist and a client. The therapist is either concurrently in another relationship with client, concurrently in a relationship with a person closely associated with the client, or promising a relationship in the future. Dual relationships impact the therapeutic alliance and/or disrupt the objectivity of the therapist. Clinical example: Denise confides in her roommate from college, who is now a therapist, that she is having suicidal thoughts. Denise begs her friend to take her on as a client since she is already comfortable with her. The therapist agrees, and there are thus multiple relationships existing between Denise and therapist, compromising the therapeutic alliance and quality of treatment.

Question 5

Duty to warn/protect

Answer 5

Part of ethical practice, the duty to warn is one of the instances in which a therapist must break confidentiality. Duty to warn means therapists have the responsibility to inform third parties if a client is at risk for harming themselves or another identifiable individual. The Tarasoff Case established that warning the authorities alone is insufficient and that the therapist must also warn the identifiable individual directly.

Example: If a therapist believes the risk their client will attempt suicide is high, the therapist has a duty to protect the client by breaking confidentiality to involve other parties or have the client hospitalized.

Question 6

Ethics

Answer 6

Part of clinical practice, ethics are the standards that govern the conduct of professional members of a group of association, including therapists. Ethical standards may conflict with morals, values, and even the law. Generally, ethics are a higher standard than what is required by law.

Example: The APA code of ethics dictates that therapists must wait two years following the termination of a therapeutic relationship to have a sexual relationship with clients, but it is legal to have a sexual relationship as long as clients have reached the age of consent.

Question 7

Ethical boundaries in clinical practice

Answer 7

Boundaries are a frame that protect the therapeutic relationship in an ethical practice. Boundaries may be physical (no physical contact) or behavioral (no gifts, self-disclosure). Therapists who practice ethically must use careful clinical judgment when deciding if it is beneficial to the client to cross a boundary. A boundary crossing could potentially benefit the client, be neutral, or potentially harm the client. A boundary violation is a boundary crossing that harms the client.

Example: A therapist agrees to conduct a therapy session while walking because movement helps the client think and dispels some of the client’s anxiety about speaking honestly. This is a boundary crossing that benefits the client.

Question 8

Legal aspects of informed consent

Answer 8

To cover legal bases of informed consent, a therapist must discuss the limits of confidentiality, the nature of therapy, and the fee structure. Clinical example: A new therapist forgets to include her rate, when payment is expected, and whether she bills insurance on her informed consent paperwork. She has not fulfilled the legal requirements of informed consent.

Question 9

Malpractice

Answer 9

Part of ethical practice, the failure of a counselor to provide the standard of care expected when treating an individual that results in direct damage to the patient.

Example: Administering a treatment one has not been trained to administer can result in malpractice. For example, if a patient presented with PTSD and a therapist who was not trained in EMDR administered that therapy.

Question 10

Privileged communication

Answer 10

Refers to the confidential communication between therapists and their clients; it is protected by law from being shared with others, although there are some exceptions (duty to warn, suspicion of abuse, court order). The client has the privilege or right to determine if and when their protected communication is shared.

Example: A patient shares with you in session that he was sexually assaulted as a child. That information is privileged and just be kept confidential by the therapist.

Question 11

Professionalism

Answer 11

Safeguarding the integrity of the counselor-client relationship. Aspects of professionalism include appropriate dress and proper behavior when interacting with a client, and appropriate behavior when in the community. One may be unprofessional without necessarily being unethical, but frequently the two are tied together.

Example: As part of professional practice, therapists should arrive on time, use respectful language, and dress appropriately.

Question 12

Values in counseling

Answer 12

Part of ethical practice, values are beliefs and attitudes based on our culture and individual preferences that provide direction for everyday living. In ethical counseling, therapists should be aware of their own values, attempt to understand their clients’, and avoid placing their own value system on the client.

Question 13

Vicarious liability

Answer 13

In clinical practice, if a therapist in training practices under an institution’s or therapist’s license, that institution or therapist has liability for the trainee’s actions. For example, supervisor is directly liable for things such as giving inappropriate advice to their trainees or allowing their trainees to practice at a higher level than they are competent at.

Clinical example: Janet was supervising a clinical counseling student and advised the student to implement EMDR, a therapy the student had not been trained in. Janet is directly liable for any harmful outcomes to the patient.

Question 14

Peer consultation

Answer 14

Part of ethical practice and a risk management approach, consulting with a trusted network of colleagues or peers on difficult cases or potential boundary violations is recommended and can ensure counselors are not acting unethically or imposing their worldview on their clients.

Example: You notice a patient you are treating is evoking some strong emotions in you and suspect countertransference. You consult with a group of trusted peers to discuss the case and get recommendations on whether or not to refer the patient.

Question 15

Morality

Answer 15

Individual’s internal value system for what is right and wrong and what constitutes right and proper conduct. In the same way that it is important for a counselor not to impose their values on their client, it is equally important that they do not impose their morality upon their client.

Question 16

Confidentiality in group or couples therapy

Answer 16

Confidentiality in group and marital counseling is fundamentally different than confidentiality in individual treatment. The therapist must still maintain confidentiality outside of this group, but there is no guarantee other members of group or marriage will keep information about other parties confidential. Additionally, in marital counseling the therapist should make it clear that there can be no secrets. The couple is the patient, not just the husband or the wife. Keeping secrets can harm the therapeutic alliance.

Example: Bill admits to having an affair during therapy. While the therapist will not break confidentiality, Bill’s wife may choose to share this information beyond the therapy room.

Question 17

Ethnic sensitive practice

Answer 17

Part of ethical practice, an ethnic-sensitive approach or practice is one that considers how the culture of a patient may impact their worldview, attitudes, beliefs, presentation of symptoms, or appropriate treatments. Counselors must be careful and self-aware enough not to apply their own worldview to the clients, but instead, attempt to understand their client’s worldview and the factors that influenced it.

Example: Tiffany is an Asian American client who often talks about her parents’ opinions of her choices in therapy. An ethnic-sensitive therapist will not be dismissive of these concerns but will understand that her worldview is collectivistic.

Question 18

Licensure v. certification

Answer 18

Part of ethical practice, licensure is a mandatory requirement to be a legal practitioner and is given out by a government board after rigorous education, training, and supervised practice. Certification is a voluntary process of acquiring knowledge and/or skills typically from a professional organization or association. Typically the requirements for certification are less rigorous than licensure.

Clinical example: Prior to beginning a private practice, Erin attended a graduate program, completed supervised internship hours, and sat for a licensure exam to ensure gained licensure from the South Carolina Board of Licensure and, therefore, be a legal practitioner. She also secured certification in TF-CBT.

Question 19

Pro bono service

Answer 19

Service that therapist provides for free, sometimes to members of the community who may not be able to afford their services. Counselors are highly encouraged and sometimes required per ethical mandate, to contribute to their community by providing pro bono services. It is important to establish boundaries and avoid allowing either party to take advantage of the situation. Example: A therapist keeps one afternoon of appointments available for pro bono services as a service to his community.

Question 20

Mens Rea

Answer 20

Part of ethical practice, mens rea is a legal phrase meaning guilty mind or guilty intent. In order for someone to be convicted of a crime, the prosecution must prove that the person engaged in the guilty act (actus reus) and that he/she had guilty intent. Psychologists can be called to talk about what a person’s intent/state of mind was at the time that a crime was committed. Did they intend to commit the crime or did the crime happen subsequent to a behavior that wasn’t meant to hurt/harm someone?

Clinical Example: You were called as an expert witness to discuss mens rea as it relates to a crime that was committed by a woman during a sexual assault. The person accused of assaulting the defendant was killed during the attack. The question you are tasked with answering is: Was it the defendant’s intent to harm the attacker or was she acting in self-defense.

Question 21

Reporting child abuse

Answer 21

Licensed therapists are mandated reporters and, therefore, required by law to report any suspected cases of child abuse to the proper authorities (DSS and the police) within 24 hours. This should be outlined in the informed consent process and discussed with the client when explaining the limits of confidentiality.

Clinical example: A patient reveals that she is worried her boyfriend is touching her children in a sexual way. The therapist is required to break confidentiality and report this suspicion to the proper authorities.

Question 22

Self-monitoring of ethical practice

Answer 22

Counselors should be aware of ethical codes and monitor themselves to ensure that they are practicing ethically. Counselors should not rely wholly on self-monitoring, and should also use peer consultations and reviews. Relying solely on self-monitoring could result in rationalization and justification for unethical behaviors.

Example: A therapist accepts a gift offered by a client. Later, she considers her clinical decision and whether it was ethical. She feels confident in the self-monitoring of her behavior, but she reaches out to a colleague to ask for a second opinion anyway.

Question 23

Sexual intimacies with former clients

Answer 23

Intimacies with current clients are prohibited while sexual intimacies with former clients are allowed 2 years after termination of therapy. It is usually best to avoid. Therapist cannot end therapy with the promise of a future sexual relationship (constitutes a multiple relationship), and must ensure that there is minimal risk of harm to their former clients. Example:

Question 24

Tarasoff case

Answer 24

Landmark case in California in 1970s, Tarasoff vs. University of California, resulted in a clinician’s duty to warn. A psychologist was treating a patient who made a threat to kill an identifiable third party. Psychologist was unable to commit the patient and the patient killed the third party. The victim’s family sued, and the ruling requires that a therapist breach confidentiality in cases where the welfare and safety of a readily identifiable 3rd party is involved. When a client communicates a threat directed at an identifiable third party to their counselor and the counselor believes that the person is in imminent danger, they must warn the individual directly instead of simply alerting authorities. Example:

Question 25

Treatment of minors

Answer 25

Parental consent (preferably from both parents) is required for the treatment of individuals under the age of sixteen, the one exception being crisis situations. Parents have a right to the record of their child unless they sign a waiver giving up that right. The therapist should ensure that therapy is age appropriate. *add something about who holds the record Example:

Question 26

Bartering of clinical services

Answer 26

Part of: Ethical practice

What: bartering refers to exchanging therapy for some non-monetary good or service from a client. Bartering is a boundary violation and should be carefully considered in advance. If a counselor decides to barter, they should draw up a contract detailing the terms of the agreement in advance.

Example: A landscape architect is unable to afford therapy services, but offers to design the therapist’s new backyard in exchange for therapy services.

Question 27

SAD Persons

Answer 27

A psychological assessment tool used to assess suicidality by looking at the risk factors of suicidal behavior.

Sex: Men

Age: 15-24, males 75+, females 45-54, 65+

Depression

Prior History

Ethanol Abuse: alcohol/drugs

Rational Thinking Loss: psychosis

Support System Loss

Organized Plan

No Significant Other

Sickness: in self or significant other

1 point for each;

• 0-2 keep watch*
• 3-4 send home; call often*
• 5-6 consider hospitalization*
• 7-10 hospitalize*

Example: A patient of yours mentions suicidal thoughts. He is single, 24 years old, is currently experiencing a depressive episode, drinks every day, and recently moved far from his friends and family. According to SAD PERSONS, he scores a 6 and you try to assess whether or not the patient has a plan before deciding to hospitalize.

Question 28

Basic Purpose of Ethical Practice

Answer 28

Primary purpose of ethical practice is to safeguard client’s well-being. Also to safeguard the public. The guiding principles of ethical practice: autonomy, beneficence, nonmaleficence (to not inflict harm intentionally), & justice can assist clinicians in this endeavor.

EXAMPLE: To protect your patients and to protect yourself as well as resisting crossing certain boundaries and knowing when to take a “mental health day” or consult.

Question 29

Direct Liability

Answer 29

Part of legal and ethical practice.

A counselor is directly liable or legally responsible for any actions they take with a client. In other words, the counselor’s license is what’s at stake when they are delivering therapeutic services.

Example: Janet was supervising a clinical counseling student and advised the student to implement EMDR, a therapy the student had not been trained in. Janet is directly liable for any harmful outcomes to the patient.

Question 30

Empirically-Supported Treatment

Answer 30

Part of ethical clinical practice, Empirically-supported treatments are interventions that have been found to be efficacious for one or more psychological conditions. Needs evidence in its favor from at least two well-designed, randomized, placebo-controlled clinical trials, equivalent to a well-established tx in several rigorous or independently controlled studies, many single-case experimental design studies, or a meta-analysis.
They have a manualized treatment protocol, can be independently replicated, & have been supported by the research of several independent investigators.

ESTs are used by clinicians employing an evidence-based practice, which is the integration of the best available research with clinical expertise in the context of the patient’s characteristics, culture, and preferences.

Example: Applied Behavior Analysis (ABA) therapy is an empirically supported treatment for children with autism spectrum disorder.

Example: Dialectical Behavior Therapy (DBT) is an empirically-validated treatment for Borderline Personality Disorder.

Question 31

Ethical Boundaries in Clinical Practice

Answer 31

Boundaries are a frame that protect the therapeutic relationship in an ethical practice. Boundaries may be physical (no physical contact) or behavioral (no gifts, self-disclosure). Therapists who practice ethically must use careful clinical judgment when deciding if it is beneficial to cross a boundary. A boundary violation is a boundary crossing that harms the client. A boundary crossing could potentially benefit the client, be neutral, or potentially harm the client.

Example: A therapist asks if she can hug a client who recently lost her mother. The client considers, looks grateful, and says yes. This is an example of an ethical way of crossing a boundary, because it is for the benefit of the client.

Question 32

Certification

Answer 32

Certification is provided by a professional association or organization indicating an individual has acquired some specialized knowledge or skills in a specific therapeutic modality or population. It is not mandatory to have certification to practice.

Example: You sign up to attend a 3-day training on a specific therapeutic approach for treating trauma: EMDR. Following the training, you are awarded a certificate and have been certified in EMDR.

Question 33

HIPAA Compliance

Answer 33

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of the U.S. Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of certain health information.

It establishes national standards to protect individuals’ medical records and other personal health information. The Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form.
The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information” (e-PHI). Within HHS, the Office for Civil Rights (OCR) has responsibility for enforcing the Privacy and Security Rules with voluntary compliance activities and civil money penalties.

A therapist must adhere to the HIPAA privacy and security rules in order to protect the information of the patient.