PSYC 514: Ethics

Question 1

SAD PERSONS

Answer 1

• An assessment tool used to evaluate an individual’s risk of suicidality and their 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
  R - Rational thought loss
  S - Separated/Divorced/Widowed
  O - Organized/serious attempt
  N - No support system
  S - Sickness

Ex: 55-year-old divorced male with a history of depression, active substance abuse, and social isolation, who is feeling hopeless and may soon be facing hopelessness due to financial challenges, would score high and require intervention to ensure safety. Therapists will want to have a toolbox of resources and recommendations available for a client who displays a risk for suicide and the ability to transport them if necessary. (988 suicide prevention and 911 medical emergency).

Question 2

Assent vs Consent to Treatment

Answer 2

Based on ethical principles autonomy and beneficence. - Consent to treatment is a legal agreement and statement of approval given by an individual for treatment. - Assent applies to minors and those not mentally competent who are providing approval but still legally require a parent or guardian provide consent to such treatment. A clinician will want to explain the nature of therapy and risk factors in terms appropriate for the individual’s age.

• Consent and Assent are seen as an ongoing process that may be revoked at any time.

Ex: A therapist is treating a 13-year-old client. In a signed document, they receive assent to treatment from the 14-year-old child as well as consent to treatment from the minor’s parents.

Question 3

Bartering of Clinical Services

Answer 3

• When a clinician accepts payment for perfessional services in change for goods or services rather then monetary payment.
• Can be considered acceptable when the value exchanged is fair and mutually agreed upon in writing but is ethically challenging due to varying interpretations of “fair value” and the risk of boundary crossing.
• Sliding-scale payments are becoming more common and requires careful consideration to ensure fairness and transparency,

Ex: Trading treatment for Clemson football tickets could be problematic if the exchange appears inequitable, creates bias, or deviates from the standard of care.

Question 4

Basic Purpose of Ethical Practice

Answer 4

• To keep the client protected through the use of guiding principles of autonomy, beneficence, nonmaleficence and justice.
• The code of ethics provides APA guidance for clinicians and is a mechanism for professional accountability
• Involves informed consent, consultation and documentation for the client’s best interest these standards ensure therapy is safe, effective, and promoting best outcomes for clients.

Ex: Providing treatment for PTSD without proper training may further jeopardizes the client’s mental health and erodes the therapeutic alliance.

Question 5

Confidentiality

Answer 5

The legal and ethical responsibility of of therapist to keep client information private.
Exceptions inlcuding:
- risk of harm to self or others including abuse of minors, elderly or those who are unable to care for themselves
- or if legal required to disclose information due to a court order.

Confidentiallity is cruitial for effective therapy, protecting client rights, and as Carl Rogers taught us, trust is the foundation of a therapeutic alliance.

Ex: A therapist will not acknowledge to others that someone is their client, even if asked directly.

Question 6

Competency to stand trial vs. Insanity Defense

Answer 6

Competency to Stand Trial is a legal determination about whether a defendant can understand the charges against them at the time of trial and assist their attorney in their defense. Competency assessments are in place to ensure that the defendant can meaningfully participate in their trial. If you are deemed incompetent, you must receive treatment with the goal of being set free to go to trial.
Insanity Defense refers to the defendant’s mental state at the time of the crime. It is a plea declaring that the defendant was unable to understand the wrongfulness of their actions due to a severe mental disorder and is relevant when determining criminal responsibility.
Not Guilty By Reason Of Insanity law shifted the burden of proof to the Defence Team to prove that a person was insane at the time of the criminal act.
Competency protects fairness of legal proceedings, while the insanity defense addresses moral accountability and ensures individuals with severe mental illnesses are treated rather than punished.

Question 7

Confidentiality in Group or Marital Counseling

Answer 7

• In marital counseling, confidentiality is nuanced in that therapists must avoid meeting with one partner without the other’s knowledge and they must ensure sessions remain balanced and equitable.
• In group couseling, confidentiality is critical for meaninful outcomes and the clinician is required to inform participants of confidentiality and ask that they respect it outside of session although they cannot guarantee that other members will.

Grounded in ACA ethical codes and HIPAA regulations, confidentiality is crucial for creating a safe space where individuals are free to express themselves.

Ex: If there is a dual relationship that exists in group therapy, you may never discuss group with any member outside of the theraputic process.

Question 8

Counselor Competency

Answer 8

• Refers to the counselor’s ability to practice well including but not limited to:
  knowledge base, commitment to continued education, understanidn of cultural diffreences and their own limitations
• Competency is vital for protecting clients and ensuring trust, while reducing risks of harm.
• Refers to their ability to practice physically, mentally, and emotionally including self-care
• Practicing without competency or not within one’s scope of practice is unethical

Ex: The ability to stay current on a multitude of topics related to your child-abuse trama clients while maintaining a self-care practice that prevents you from bringing the work home with you in an unhealthy way.

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 when a therapist fails to meet their duty of care through negligence or misconduct.
• it protects the client/public by holding the clinician accountable for their actions
• You my reduce the risk of liability by following ethical guidelines, staying competent, be away of dual-relationship, holding a steady standard of care and by keeping good records.

Ex: Being investigated by the state and risk of losing license to practice as a restult of overbilling clienst/fraud.

Question 10

Dual/Multiple Relationships

Answer 10

• Refers to when a clinician has another type of relationship with a client that goes beyond a therapeutic relationship
• It is considered best practice to avoid multiple relationships when possible and when not possible important to carefully managed, discuss, and document the agreed terms of the relationship to prevent conflicts of interest or harm to the client.
• rooted in ethical standards from ACA, which caustions re boundaries and an impact to the therapeutic process.

Ex:Therapist and client have children that attend the same school and often cross paths outside of session.

Question 11

Duty to Warn/Protect

Answer 11

• Outcome of the Tarasoff v. Regents of the University of California case, its the legal and ethical obligation of mental health professionals to warn and/or protect third parties who their client expressed an intent to harm
• In events where one may be able to protect a suicidal client from self-harm
• Is essential in therapy to balance client confidentiality with the need to prevent harm. -
• Proper documentation and peer-consultation is key to navigating appropriately.

Ex: Your client said that he is going “to kill” his estranged wife if she gets custody of the children in their divorse case.

Question 12

Morals in Counseling

Answer 12

• A belief system that is more subjective and shaped by personal experiences, emotions, and culture and often reflects a person’s deepest convictions.
• clinician must be mindful of not imposing their own morals on their clients

Ex: in America it is frounds upon to have affairs outside of your marriage.

Question 13

Ethical Boundaries in Clinical Practice

Answer 13

• Protect the integrity of the therapeutic relationship and ensure it remains professional and client-centered.
• Guidelines put in place to make the therapeutic relationship distinct from personal, intimate, and business relationships
• violtations of boundaries may cause harm to the client’s wellbeing or the theraputic alliance.
• Crossing a boundary may not be innately harmful, but it removes the clinician from a neutral position and stand of care.

Ex: Making personal phone calls, home visits or keeping in touch via social media platforms to check in on cients that go beyond stand of care.

Question 14

HIPAA Compliance

Answer 14

• U.S. law ensuring confidentiality and security of Protected Health Information (PHI).
• HIPAA compliance is done by maintaining confidentiality of the client’s identity as well as the content of their session(s)
• Integral to clinical practice, aligning with ethical principles like confidentiality and beneficence and outlined by the APA.

Ex: Sharing patient names and contact information is a HIPAA violation.

Question 15

Legal Aspects of Informed Consent

Answer 15

THREE legal aspects of informed consent
1. Confidentiality and its limits
2. Nature of therapy and how sessions will be structured
3. Fees of treatment
- Client must have the capacity to understand these aspects prior to their voluntary consent to treatment
- A signature of consent/asent is legally required and highlights the patient’s right to make informed decisions about their healthcare.
- Failure to receive informed consent properly can result in legal consequences.

Ex: Making sure that your client understands the cancelation policy including late and no-show fees is critical as failure to make this policy known damages trust and may open the clinitian up to legal scruitny.

Question 16

Licensure vs. Certification

Answer 16

Certification:
- an acknowledgment that a person has met certain qualifications to perform a specific job/task
- Indicates that a person possesses a specific set of knowledge, skills, and abilities to effectively practice under that certification
- Certifications are not monitored by any board

Licensure:
- mandated and regulated by a government-controlled board
- required by law in order to practice

Ex: John is licensed as a professional counselor in South Carolina. This license is overseen and controlled by the SC Board of Counselors. John also received a certification in PTSD therapy. This certification states that they completed the required coursework for the certification, but it is not managed or overseen by any board.

Question 17

Malpractice

Answer 17

• Malpractice is a legal term defining professional misconduct or negligence where a provider fails to meet required standards of care, resulting in harm to the client.
  When harm occurs, legal action may be pursued through lawsuits and disciplinary measures. Understanding malpractice helps practitioners mitigate risks, protect client’s well-being, and maintain professionalism.

“Four D’s” of malpractice outline the necessary elements for legal action:
1. clinician had a duty to the injured person
2. clinician deviated from standard of care
3. The client suffers damage that is able to be measured or observed.
4. direct link/relationship between the damage sustained and the provider’s actions.

Ex: Emotional trauma and self harm results from inappropriate boundary violations when therapist enters a romantic relationship with the client.

Question 18

Peer Consultation

Answer 18

• Process of mutual benefit where professionals work together to discuss challenging cases, share insights, and offer constructive feedback, helping each other improve their practice or to mitigate risk.
• Essential for risk management and supports objectivity in regard to biases
• Promotes professional growth, reduces burnout, and creates a supportive environment for enhancing competency.

Ex: Clinician seeks peer consultation re how to approach a sensative topic in an upcoming group therapy session that may upset certain memebers of the group.

Question 19

Power Dynamics

Answer 19

• Refers to the imbalance of power and/or influence clinicians may hold over their patients.
• Imbalance can impact the effectiveness of therapy if clients feel disempowered and does not fully participate in the process.
• As a therapeutic alliance is built, a mutual relationship emerges creating a safe space for the client to transfer elements of power to the therapist allowing the therapist to guide and support them.
• Professionals must be aware of power dynamics and work to create a collaborative environment where the client feels empowered and respected when making decisions about their care.

Ex: Counselor chastises client making their behavior feel silly and immature which causing the client to stop sharing additional details about an event that was significant them.

Question 20

Privileged Communication

Answer 20

• Refers to confidential communications between a client and professional that are legally protected from disclosure unless client provides consent or in very specific exceptions.
• Allows space for clients to share personal information without fear that it will be exposed.
• Fosters open and honest communication, which is essential for effective therapy.
• Clinicians hold privilege of client records, though clients may access their record at any time

Ex: Client shares that they consistently cheat on their exams at school. Therapist cannot disclose this as it does not pose a direct threat or harm to self or others.

Question 21

Pro Bono Service

Answer 21

• Therapeutic services that are offered at no charge
• Not ethically required but strongly encouraged as a means to help ensure that financial barriers do not prevent individuals from accessing mental health care.
• Offering pro bono services can enhance a professionals understanding of diverse client needs
• maintain clear communicaiton when offered so as not to deviate from the standard of practise

Ex: Felicia provides pro bono services to clients in a mental health clinic in a low income area of Charleston. While this is not required of her, Felicia provides these services so that low-income clients may have the same access to mental healthcare as their higher-income counterparts do. In return, Felicia is exposed to an socioconomic group that she otherwise would not be, deepenimg her understanding of needs in her local community.

Question 22

Professionalism

Answer 22

• Refers to the competency of the clinician to perform the skills expected by their chosen profession
• Maintains characteristics that support ACA ethical standards, providing clearand compassionate care.

Aspects of professionalism include:
1.competence, knowledge and continuous learning
2.conscientiousness
3.integrity and high standards of behavior
4.respect by treating all with dignity
5.emotional intelligence
6.appropriate judgment and professional discernment
7.confident belief in one’s abilities to provide care.

Ex: Creating a clean and comfortable office environment, maintaing professional boundaries and speaking to clients in a kind and respectful way allows a therapist to conduct themself professionally.

Question 23

Reporting Child Abuse

Answer 23

• Legally required to report suspected child abuse to the appropriate authorities, such as child protective services (CPS) or law enforcement without needing absolute confirmation of abuse.
• Recognizing signs of abuse, like unexplained injuries or behavioral changes, and assessing the situation while prioritizing the child’s safety.
• Document observations and actions taken ensuring legal compliance and if treatment was continuted after report was made.

Question 24

Self-Monitoring of Ethical Practice

Answer 24

• A method of behavior management in which the clinician monitors their own ethical practices
• Involes self awareness, reflection and accounability
• Abilty to pivot or change methods when necessary to be a competent provider
• This is done by maintaining self care strategies and being 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

Ex: Tom, LPC feels himself growing exhausted by his client and allows his mind to wander during session. Tom knows he must find new ways to engage this client and consults with a peer for recommondations. Additionally, before their next session, Tom makes a note to engage in a mindfullness exercise so as to be fully present for the session.

Question 25

Sexual Intimacies with Former Clients

Answer 25

• “Once a client, always a client”
• State ethical codes say that sexual contact has a statute of limitaions after termination (2 years in SC), it is best practice to NEVER engage in any sort of sexual intimacy with former clients

Question 26

Tarasoff Case

Answer 26

• Landmark legal ruling in Tarasoff v. Regents of the University of California which established the duty to protect third parties from harm.
• Client confidentiality may be breached to fulfill a duty to protect highlighting the balance between client rights and societal safety.
• Resulting from a tragic experience when a university grad student confided to his therapist his intent to kill Ms. Tarasoff. The therapist informed campus police and a brief investigation was conducted, yet the murder was able to be carried out. If this were to happen today, the counselor would be required by law to directly warn the named party, not only the police.

Question 27

Treatment of Minors

Answer 27

• Parental consent is required for treatment of clients under the age of 18, with the exception of crisis situations such as if the child is in imminent danger of self-harm.
• Biological parents have rights to the child’s record and the record should be given to each parent (if applicable) when requested.
• Clinician must consider limited confidentiality, consent vs assent, and their scope of practice to work with minors
• Influenced by Erik Erikson, consider the minor’s cognitive and emotional maturity when engaging in therapy. Particularly relevant in addressing trauma and family conflict.
• Counselors must balance the child’s rights, parental involvement, and legal obligations, such as reporting abuse or harm.

Ex: You client is a child is in the middle of a battle for custody with divorcing parents. The counselor must remember that while the minor is their client, there will be presure from and an expectation by the parents for shared information. This limited confidentiality is your duty to professionally manage always keeping the best interests of your client, the child, in mind.

Question 28

Values in Counseling

Answer 28

• Personal beliefs, principles, and standards that influence the counselor and the client.
• Values shape attitudes, behaviors, and decision-making within the therapeutic relationship.
• Carl Rogers emphasized the importance of unconditional positive regard and respecting client autonomy, regardless of differing values.
• Differences in religious and political views or lifestyle C30requires sensitivity and respect for fostering an inclusive, nonjudgmental therapeutic environment.
• Counselors who are aware of their values AND prioritize the client’s perspectives create a foundation for trust, empowerment, and growth.

Ex: A counselor who listens and is curious to understand the challenges their client is facing as a transwoman disowned by her parents, even when the counselor admittedly does not fully understand the diverse trans worldview.

Question 29

Vicarious Liability

Answer 29

• Legal principle that holds individuals or organizations accountable for the misconduct or negligence of their employees.
• Within counseling, the licensed profession is responsible for the actions of anyone working under their license (i.e. supervisees, office staff, etc.)
• Responsible for ensuring those working under them are well trained
• Any breaches of confidentiality or malpractice, holds the clinician legally and ethically liable, meaning they could receive a lawsuit or have their license suspended/revoked.

Ex: Dr. Ward trains his office staff to respond appropriately to clients that call in crisis if he is unavailable or after hours. His front office staff broke confidentiality after one of these calls exposing Dr. Taylor to vicarious liability action.