PSYC 514: Ethics

Question 1

SAD PERSONS

Answer 1

• A mnemonic used to assess an individual’s level of suicidality and their corresponding risk/need for a higher level of care
  S - Sex (males higher risk)
  A - Age (45 higher risk)
  D - Depression
  P - Prior psychiatric history
  E - Excessive substance use (impulsivity/judgment impairment higher risk)
  R - Rational thought loss
  S - Separated/Divorced/Widowed
  O - Organized/serious attempt
  N - No social supports
  S - Stated future intent

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Question 2

Assent vs Consent to Treatment

Answer 2

• Consent is the legal agreement or approval given by an individual, specifically permission granted by an individual for medical or psychological treatment, participation in research or both
• for assent, clinician should explain nature of therapy and risk factors in terms the individual understands
• Consent is seen as an ongoing process that may be revoked at any time
• Assent is verbal statement to agree to treatment given by a minor who is unable to legally consent, but is willing to participate.
• Assent can also be for those not mentally competent

Ex: Felicia, LPC is treating a 14-year-old client. She receives consent in a signed document from the client’s parents and verbal assent to treatment from the 14-year-old child.

Question 3

Bartering of Clinical Services

Answer 3

• When a clinician accepts payment for their services that is non-monetary
• Bartering of services is not looked at as favorable but technically can be done if it’s not clinically contraindicated
• If a clinician does engage in bartering, the terms need to be clearly outlined in a written contract to make sure the client is not being taken advantage of

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Question 4

Basic Purpose of Ethical Practice

Answer 4

• To keep the client protected
• Guiding principles to be adhered to are autonomy, beneficence, nonmaleficence and justice
• The code of ethics can also provide guidance for clinicians and be a mechanism for professional accountability
• Involves adequate informed consent, consultation and documentation for the client’s best interest

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Question 5

Certification

Answer 5

• Statement or acknowledgment that a person has met certain qualifications to perform a certain job/task
• Indicates that a person possesses a certain set of knowledge, skills and abilities in order to effectively practice under that certification
• Unlike licensure, are not monitored by any sort of board
• certifications are good, but licensure is necessary

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Question 6

Confidentiality

Answer 6

• Responsibility of a clinician to not reveal anything about a client (including their identity) without the explicit written permission of a client (typically via a release of information form)
• Can only be broken in the client threatens to harm themselves or specific others, reveals abuse of a vulnerable population (children, elderly, disabled), or receives a court order signed by a judge
• Breaching confidentiality without probable cause may lead to a lawsuit or suspension/loss of licensure
• is necessary so client feels like it’s a trustworthy environment

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Question 7

Confidentiality in Group or Marital Counseling

Answer 7

• In a group or marital counseling setting, clinician is required to inform participants of confidentiality and ask that they respect it outside the session time
• While the clinician must legally maintain confidentiality, there is not guarantee that other members in the session will do the same

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Question 8

Counselor Competency

Answer 8

• Refers to the counselor’s knowledge base and ability to practice well
• Refers to their ability to practice physically, mentally, and emotionally
• Practicing without competency or not within one’s scope of practice is considered unethical

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Question 9

Direct Liability

Answer 9

• Refers to when a person who committed an unethical act is held accountable professionally and potentially legally
• The burden of responsibility lands on the clinician themselves
• it protects the public by holding the clinician accountable for their actions

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Question 10

Dual/Multiple Relationships

Answer 10

• Refers to when a clinician has another type of relationship beyond a therapeutic relationship with a client
• The therapist is either concurrently in another relationship with the client, with a close friend/relation, or promises to enter into a relationship in the future
• It is considered best practice to avoid multiple relationships when possible

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Question 11

Duty to Warn/Protect

Answer 11

• The obligation of mental health professionals to warn and/or protect third parties who their client intends to harm or who might be able to protect a suicidal client from self-harm
• Came from the Tarasoff Case

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Question 12

Empirically-Supported Treatments

Answer 12

• Have evidence on favor of treatment from at least 2 well-designed randomly controlled trials
• Several single-case experimental designs
• OR a meta-analysis
• Used by clinicians utilizing evidence-based practice

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Question 13

Ethics

Answer 13

• Principles of morally right conduct that is accepted by a specific field
• These standards govern the conduct of professionals and are typically outlines in a written code of ethics

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Question 14

Ethical Boundaries in Clinical Practice

Answer 14

• Guidelines that are put in place to make the therapeutic relationship distinct from personal, intimate, and business relationships
• These boundaries are in place to protect the client’s wellbeing
• Crossing a boundary may not be innately harmful, but it removes the clinician from a neutral position
• Boundary violation causes harm to the client (different that boundary crossing)

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Question 15

Ethnic-Sensitive Practice

Answer 15

• Practice in which the counselor is aware of their client’s culture and ways in which their culture may affect their worldview and/or presentation of symptoms
• Ethnic-sensitive practice involves a conscious effort by the clinician to grow their multicultural competence

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Question 16

HIPAA Compliance

Answer 16

• This occurs when the therapist upholds the client’s privacy rights and protection of the client’s health information
• HIPAA compliance is done by maintaining confidentiality of the client’s identity as well as the content of their session(s)

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Question 17

Legal Aspects of Informed Consent

Answer 17

• THREE legal aspects of informed consent
• 1. Limits of confidentiality
• 2. Nature of therapy
• 3. Fees of treatment
• The client must have the capacity to understand these aspects prior to their voluntary consent to treatment

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Question 18

Licensure vs Certification

Answer 18

• Licensure is mandated and regulated by a government-controlled board
• Licensure is required by law in order to practice
• Certification means the clinician has completed appropriate course content and/or training on a specific topic
• Certifications are not regulated by a board

Ex: Felicia is licensed as a professional counselor in the state of South Carolina. This license is overseen and controlled by the SC board of counselors. Felicia also received a certifications in EMDR therapy. This certification states that she completed the required coursework for the certification but it is not managed or overseen by any board after it is presented to Felicia.

Question 19

Malpractice

Answer 19

• Refers to professional misconduct or negligent behavior on the part of the clinician
• Malpractice can lead to legal action in which the person claimed to be injured needs to prove FOUR things
• 1. the clinician had a duty to the injured person
• 2. the clinician deviated from the standard of care
• 3. the individual claiming malpractice has been injured
• 4. there was a direct link between the damage sustained and the professionals deviation

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Question 20

Morality

Answer 20

• A system of beliefs of a set of values relation to appropriate conduct
• This set of beliefs is the standard against which a behavior is judged to be acceptable or unacceptable
• This is typically an internal value system and the clinician must be mindful of not imposing their own morals on their clients

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Question 21

Peer Consultation

Answer 21

• Occurs when a clinician seeks out other mental health professionals to provide critical and supportive feedback about professional issues in practice
• Essential in a risk management model and allows them to maintain objectivity (in regard to biases)

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Question 22

Privileged Communication

Answer 22

• Refers to confidential information that may not be divulged to a third party without the knowledge and consent of the individual whose information is being shared
• Typically occurs in a professional relationship
• Clinicians hold privilege of client records, though clients may access their record at any time with the understanding of the risk associated

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Question 23

Pro Bono Service

Answer 23

• Therapeutic services that are offered at no charge
• Not ethically required but strongly encouraged as a means to break barriers to care

Ex: Felicia provides pro bono services to clients in a free mental health clinic in a low income area of Charleston. While this type of service is not required, Felicia provides these services so that low-income clients may also have access to mental healthcare as their higher-income counterparts have.

Question 24

Mens Rea

Answer 24

• Legal term meaning guilty mind or guilty intent
• To be convicted of a crime, the prosecution must prove that the person engaged in the guilty act and that s/he 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?

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Question 25

Professionalism

Answer 25

• Refers to the competency of the clinician to perform the skills expected by their chosen profession
• A clinician can be unprofessional without being unethical, however, the two typically go hand-in-hand
• Aspects of professionalism include appropriate dress, proper behavior when interacting with a client, and appropriate behavior when in the community

Ex: Felicia, LPC dresses modestly, holds professional boundaries and speaks with clients in a kind and therapeutic way. She conducts herself with these same standards in public community settings. Felicia exhibits professionalism as expects by clinicians.

Question 26

Reporting Child Abuse

Answer 26

• Clinicians are required to report child abuse to appropriate authorities
• Clinician should NOT investigate these claims as an improper investigation can lead to reasonable doubt, which in turn may hurt rather than help the child’s case

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Question 27

Self-Monitoring of Ethical Practice

Answer 27

• A method of behavior management in which the clinician monitors their own ethical practices
• This is done by maintaining self care strategies and other forms of competence, changing methods when necessary, to be a competent provider
• Clinicians need to be able to identify when they need to take a step back
• Clinicians should not rely solely on self-monitoring, but rather incorporate the use of peer consultation when necessary

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Question 28

Sexual Intimacies with Former Clients

Answer 28

• “Once a client, always a client”
• Though the ethical codes say that sexual contact is okay 5-7 years after termination (depending on which code you are viewing), it is best practice to NEVER engage in any sort of sexual intimacy with former clients

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Question 29

Tarasoff Case

Answer 29

• A 1976 Supreme Court decision which places limits of a client’s right to confidentiality
• This ruling stated that mental health practitioners, who knew or reasonably believed that a client posed a threat to another person, are obligated to protect the identifiable victim from danger

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Question 30

Treatment of Minors

Answer 30

• Parental consent is required for treatment of clients under legal age of adulthood, with the exception of crisis situations
• The biological parents have rights to the child’s record and the record should be given to each parent (if applicable) if one requests the record
• The clinician must consider this limited confidentiality, consent vs assent, and their scope of practice to work with minors

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Question 31

Values in Counseling

Answer 31

• Beliefs and attitudes that provide direction for everyday living
• Clinicians need to be mindful not to impose their values on their clients, especially if said values do not align with the clients
• If client values differ from the clinician, the clinician must be empathetic and nonjudgmental about these differences

Ex: Felicia, LPC has a value of always being kind to others. However, she has a client that believes that unkindness is “called for” sometimes. Felicia should not impose her own value of always being kind on her client and instead show be empathetic and nonjudgmental to their client and their previous experiences.

Question 32

Vicarious Liability

Answer 32

• Term meaning the clinician is responsible for the actions of anyone working under their license
• The licensed clinician is vicariously liable and legally responsible for those working under them (i.e. supervisees, office staff, etc.)
• clinicians are responsible for ensuring those working under them are well trained
• if there is any breaches of confidentiality or malpractice, the clinician is legally and ethically liable, meaning they could receive a lawsuit or have their license suspended/taken away

Ex: Dr. Taylor trains his office staff to respond appropriately to clients that call in crisis if he is unavailable. His front office staff broke confidentiality after one of these calls. Dr. Taylor is vicariously liable for the actions of his front office staff breaking confidentiality, even in the appropriate time/manner. If they break confidentiality in an unethical way or at an inappropriate time he may face the repercussions.