PSYC 514: Ethics Flashcards
SAD PERSONS
- 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 attempts
E - (Extacy) Excessive substance use
R - Rational thought loss
S - Support System (lack of)
O - Organized/serious attempt
N - No Partner
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).
Assent vs Consent to Treatment
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.
Bartering of Clinical Services
- When a clinician accepts payment for perfessional services in change for goods or services rather then monetary payment.
- Considered acceptable but slippy slope.
- When the value exchanged is fair and mutually agreed upon IN WRITING its still challenging bc interpretations of “fair value” are subject to personal interprestation
- Risk of boundary crossing.
- May create bias
Ex: Trading treatment for Clemson football tickets could be problematic if the exchange appears inequitable, creates bias, or deviates from the standard of care.
Basic Purpose of Ethical Practice
- 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.
Confidentiality
The legal and ethical responsibility of of therapist to keep client information private.
- Part of the ongoing process of consent/assent to treatment :
Exceptions inlcuding:
- Part of the ongoing process of consent/assent to treatment :
- 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.
Confidentiality in Group or Marital Counseling
- In marital counseling, confidentiality is nuanced in that therapists must avoid triangulation and meeting with one partner without the other’s knowledge. Sessions remain balanced and equitable to protect theraputic alliance.
- 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.
- Main difference is ability to uphold in group.
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.
Counselor Competency
- Refers to the counselor’s ability to practice well including
scople of knowledge, continued education, understanding of cultural competency, self-care and awareness of their own limitations and bias - Pillar of an Evidence Based Practice
- Vital for protecting clients and ensuring trust, while reducing risks of harm
- Practicing without competency can be considered unethical
Ex: You have a client who recently expereinced a trama which becomes the focal point of your sessions. You are not a trama informed therapist and feel the work is now outside your scope of expertise. Making the decision to refer this client out so that they may best address the trama, is a demonstration of your competency as a counselor.
Direct Liability
- Refers to when a person/professional who commits an unethical act is held accountable professionally and potentially legally.
- The burden of responsibility lands on the clinician themselves when failing to meet their duty of care through negligence or misconduct.
- 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, and by keeping good records.
Ex: Your practise provides a sliding scale payment option but your do not keep clean and accurate records and accidentaly billed a client twice. You are now being investigated by the state and are at risk of losing your license as a result of suspected overbilling and client fraud .
Dual/Multiple Relationships
- 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.
- ACA ethical standards warns about the impact may have to the therapeutic process.
Ex:Therapist and client have children that attend the same school and often cross paths outside of session. Therapist used start of next session to address options. Agree to maintain ….
Duty to Warn/Protect
- Outcome of the Tarasoff v. Regents, its the legal and ethical obligation of mental health professionals to warn and protect 3rd parties who are named by their client with an expressed intent to harm
- Proper documentation and peer-consultation is necessary to navigating appropriately.
- Applies to a suicidal client who may self-harm
- Essential to balance client confidentiality with the need to prevent harm.
Ex: Your client said that he is going “to kill” his estranged wife if she gets custody of the children in their divorse case. You have a duty to warn the estranged wife as well as law inforcement.
Morals vs. Values vs. Ethics in Counseling
For a strong therapeutic alliance, it is critical that the clinician not impose their personal E/M/V onto the client.
Ethics:
- A framework for determination what is consider right and wrong. Think rules.
- Standards that govern the conduct of professionals and are typically outlined in a written code of ethics.
Ex: APA: Practice competently so as to do no harm.
Morals:
- Subjective and can vary between individuals and cultures.
- Personal principles (origins) that shape understanding of right and wrong
- Influence decisions and overall behavior.
Ex: In America it is founded upon to have affairs outside of marriage.
Values:
- System that guides a person’s behavior.
- Tied to identity, personality and life choices.
Ex: Believing that love is love regardless of gender is a personal value.
Licensure vs. Certification
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
- 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.
Malpractice
- Malpractice is a legal term defining professional misconduct or negligence where a professional 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 result from inappropriate boundary violations between a minor client and their therapist. Parents sue therapist for malpractice.
Peer Consultation
- 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
- Important bc it 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.
Privileged Communication
- Legal principlate that 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: Your minor client is in therapy for depression and anxiety. They disclose to you that they are using illegal drugs to manage their symptons. You do not share this information with the clients parents as they are not in immediate danger and you are honoring their privileged commuincaiton.
Pro Bono Service
- Therapeutic services that are offered at no charge (different than bartering and sliding scale.)
- Ehically encouraged as a means to help ensure that $ barriers do not prevent individuals from accessing mental health care.
- Offering pro bono services can enhance a professionals understanding of diverse client needs
- Document when offered so as not to deviate from the standard of practise
Ex: Felicia provides pro bono services to clients in a low income area of Charleston. While not required of her, Felicia provides these services so that low-income clients may have the same access to mental healthcare as the rest of the members of her practise. In return, Felicia is exposed to a socioconomic group that she otherwise would not be, deepenimg her understanding of needs in her local community.
Reporting Child Abuse
- Legally required to report suspected child abuse to the appropriate authorities, such as child protective services (CPS) or law enforcement within 24 hrs of knowledge
- Do not need absolute confirmation of abuse.
- Recognizing signs of abuse, like unexplained injuries or behavioral changes
- Document observations and actions taken ensuring legal compliance and if treatment was continuted after report was made.
- Important tto Assessing the situation while prioritizing the child’s safety.
Self-Monitoring of Ethical Practice
- 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 provide competent care
- Maintaining self care strategies and being able to identify when they need to take a step back or seek peer consultaiton
Ex: Tom, LPC feels himself growing exhausted by his client and allows his mind to wander during their session. Tom knows he must find new ways to engage this client and consults with a peer for recommondations. Before their next session, Tom makes a conscience effort to engage in a mindfullness exercise so as to be fully present for his client.
Sexual Intimacies with Former Clients
- “Once a client, always a client”
- clear Boundary violation
- Open you up to malpractise claim
- APA and State ethical codes dictate a statute of limitaions after termination of client relationship
- Best practice to NEVER engage
Tarasoff Case
- Landmark legal ruling in Tarasoff v. Regents which established Duty to Warm which protects 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.
Treatment of Minors
- 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.
Vicarious Liability
- 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 by disclosing a client’s name after receiving a call over the weekend. This behavior exposes Dr. Taylor to vicarious liability action.
