PSYC 514 - Ethics Flashcards
Assent v. consent to treatment
In clinical practice, the client must agree that they would like to engage in therapy with the counselor and that they know what is expected of them in that process. individuals who have reached the legal age of consent (18 in the US) can 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.
Confidentiality
The primary responsibility of an ethical practictioner, confidentiality is an obligation to keep information discussed in counseling private. The confidentiality that is provided allows the client to disclose information and build a therapeutic relationship. 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. ClinicalExample: A therapist learns her patient, a child, is being sexually abused by her father and breaks confidentiality by reporting this to the police.
Counselor competency
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.
Dual/multiple relationships
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. Can be a boundary violation or crossing. 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.
Duty to warn/protect
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 and authorities 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.
Ethics
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. It is important to follow ethics in order to keep yourself and your client safe and practice at the highest standard. Example: John reaches out to you after being your client last year and wants to know if you would like to join him for dinner and a movie. Ethically, you are not allowed to join in a sexual relationship with John at this time.
Ethical boundaries in clinical practice
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: Erica comes to therapy with you and brings with her a gift when she arrives. You must explain to her that you cannot accept this gift. Accepting this gift would be a boundary crossing and could potentially affect the relationship negatively if she expected something in return.
Legal aspects of informed consent
To cover legal bases of informed consent, a therapist must discuss the limits of confidentiality, the nature of therapy, and the fee structure. This provides legal protection for the therapist and sets up important expectations for the client. Client must then given their consent to treatment. Clinical example: As a counselor who practices ethically, Amy discussed confidentiality and when it might be broken, the nature and aspects of therapy, and the fees associated with sessions in her informed consent.
Malpractice
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. 4 things must be proven: the professional had a duty to person injured, they deviated from standard of care, the individual has been damaged, and there is a direct link between the damage and deviation. (Duty, Deviated, Damaged, Direct Link) Example: Tara is a therapist who has not been trained in EMDR but is engaging in therapy with clients to undergo this treatment. Her deviation from the standard of care (getting formal training) leads to the damage of one of her clients, who is claiming malpractice.
Privileged communication
The legal term that refers to the legal right of the individuals to withold information in judicial proceedings under limited circumstances. This right protects the client and the confidentiality. The therapist holds the privelege of sharing information in a legal setting. Example: A patient shares with you in session that he was sexually assaulted as a child and suffers from PTSD. In a legal setting, the counselor holds the privelege of sharing that information or keeping it confidential to protect the client.
Professionalism
How a professional presents themself. 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.
Values in counseling
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. Example: Tara comes into counseling and is concerned that her parents are overbearing and controlling. She comes from an Asian family where this is typical, but you as a therapist must be sure not to impose your cultural values on Tara’s decisions.
Vicarious liability
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. 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. This is to protect the client even under the care of someone in training or front desk staff. 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.
Peer consultation
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.
Morality
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. Example: Tara comes into therapy and is depressed, trying to decide if she should have an abortion or not. You as a therapist must not impose your values on your client regarding your stance on abortion.