PSYC 514 Ethics

Question 1

Assent vs consent to treatment

Answer 1

part of Ethics & law, clinical practice. Consent may only be given by individuals who have reached legal age of consent (in the U.S., typically 18). Assent is the agreement of someone not able to give legal consent to participate in an activity i.e. therapy. Assent occurs when therapist makes sure child understands therapy process at developmentally appropriate level & has them provide their assent to treatment, or willingness to participate in therapy. 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

EXAMPLE: Billy, who is 10 years old, is brought into a clinician’s office by his parents who are seeking individual therapy for Billy’s behavioral problems in school. In order for the clinician to provide individual therapy to Billy, each parent must consent by signing an agreement. The clinician then explains to Billy the therapy process and presents him with the agreement to sign saying that he assents to treatment. Billy tells the clinician he is willing to participate in therapy and gives his assent. Billy can only provide assent, not consent, because of his age.

Question 2

Bartering of clinical services

Answer 2

the exchange of goods (chicken, cabinetry, painting, etc.) or of services (automobile repair, plumbing, house cleaning, etc.) for psychotherapy services. Not looked on favorably in terms of ethics but may be done in some cases. If bartering is done, the terms of bartering should be clearly stated in a written contract.

EXAMPLE: Tommy could not pay monetarily for his sessions, but was skilled in lawn care. He and his therapist constructed a contract in which he would do landscaping for her yard while she provided therapeutic services.

Question 3

Basic purpose of ethical practice

Answer 3

part of Ethics & clinical practice. 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 4

Certification

Answer 4

part of Ethics & Clinical Practice. A certification is a statement of confidence from an agency that a person is qualified to perform certain job or task. It indicates that the individual has a certain set of knowledge, skills, or abilities in the view of the certifying body. Certifications are given to professionals (i.e., therapist) by a group of peers as opposed to a governmental agency. This is different than licensure. When certified, no governing body is overseeing the people who have the certification.

EXAMPLE: Alicia became approved by an organization to be an Addictions Counselor, thereby receiving certification for that skill.

Question 5

Confidentiality

Answer 5

part of the ethical guidelines for psychologists, confidentiality means that the information between a patient and a therapist cannot be shared with anyone. There are a few exceptions to confidentiality, and these must be explained to the client prior to beginning treatment. Psychologists can disclose private information without consent in order to protect the patient or another person from serious harm - called the duty to warn/protect. Psychologists are required to report ongoing domestic violence, abuse or neglect of children, the elderly or people with disabilities. Psychologists may release information if they receive a court order signed by a judge or a judge’s subpoena.

EXAMPLE: a counselor can breach confidentiality if their client mentions recently being sexually assaulted by their father. The counselor is obligated by law to report this abuse to the proper authorities.

Question 6

Confidentiality in group or marital counseling

Answer 6

part of ethics, law & clinical practice. Confidentiality in group and marital counseling is fundamentally different than individual setting. 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: If a couple comes in for marital therapy and the husband tells the therapist that he still has an ongoing affair that he does not intend on stopping, the therapist would have to disclose this to his wife due to the no secrets rule and the effect it would have on future sessions

Question 7

Counselor competency

Answer 7

competency refers to the quality of having adequate or better ability to perform some task physically, emotionally, or otherwise. Counselors have an ethical obligation to practice only within the boundaries of their competence, based on their education, training, supervised experience, credentials and professional experience. Counselors maintain competence through continuing education of current scientific and professional information in their fields. If personal problems arise that may affect a counselors’ competency, they cease counseling activities and seek adequate measures for these issues.

EXAMPLE: If a counselor develops a severe drinking problem in light of her father’s death, it is her ethical obligation to cease therapy because she is no longer competent.

Question 8

Direct Liability (primary liability)

Answer 8

from legal aspects of clinical practice. In supervisor/supervisee relationship, the supervisor is directly liable for any actions on their part which may lead their trainee to make mistakes in clinical practice. A 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.

For example, a supervisor has a student carry out inappropriate treatment or asks the student to complete a task in which the supervisor knows (or should know) the student is not skilled or knowledgeable.

EXAMPLE: Ted was supervising a trainee named Jasmine and he advised her to terminate therapy with a patient who was clearly not ready for termination. Ted is directly liable for this.

Question 9

Dual/multiple relationships

Answer 9

refers to any situation where 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. It is best to avoid multiple relationships if AT ALL possible because dual relationships affect the therapeutic alliance and/or disrupt the objectivity of the therapist
Examples of dual relationships are when the client is also a student, friend, family member, employee or business associate of the therapist.

EXAMPLE: If a close friend of mine has a child who is acting out in school and she asks me to counsel him, I would refer him to someone else because of my close and frequent contact with her son and the rest of the family.

Question 10

Duty to warn/protect

Answer 10

part of clinical practice & mental health law that refers to the responsibility of a counselor or therapist to inform third parties or authorities if a client poses a threat to himself or herself or another identifiable individual. The Tarasoff Case established that warning authorities alone is not enough. The clinician must also warn the identifiable individual themselves. It is one of just a few instances where a therapist can breach client confidentiality.

EXAMPLE: A client mentions that he is planning on killing his sister this week. The therapist should inform the police and his sister in order to keep her safe.

Question 11

Empirically-validated treatments

Answer 11

part of ethical clinical practice. Empirically-validated treatments are therapies that have well-defined treatment protocol, can be independently replicated, & have been supported by the research of several independent investigators. Needs evidence in its favor from at least two well-designed, randomized, placebo-controlled clinical trials; many single-case experimental design studies; or a meta-analysis. Used by clinicians practicing evidence-based treatments, which is the integration of the best available research with clinical expertise in the context of the patient’s characteristics, culture, and preferences.

EXAMPLE: A therapist decides to use CBT with a patient who has depression as there is a lot of research and data to support CBT as an effective treatment for depression. CBT is an empirically-validated treatment for depression.

Question 12

Ethics

Answer 12

part of clinical practice; standards which govern the conduct of professional members. Most skilled professions (including counselors and therapists) have codes of ethics that members must abide by. Conflicts may arise in areas where codes, laws, values, and morals don’t align. Generally, ethics are a higher standard than what is required by law.

EXAMPLE: The law says that you can have sexual relations with your client if they are of age. The APA ethics code, however, says you must wait until 2 years after the therapeutic relationship has ceased to carry on a relationship.

Question 13

Ethical boundaries in clinical practice

Answer 13

boundaries which limit nature of therapist & client interaction in order to protect the therapeutic relationship & the client’s well-being. Boundaries in clinical practice may involve physical boundaries (proxemics) and areas of discussion that are off limits. Therapists must adhere to ethical codes regarding boundaries, but also use clinical intuition/judgment when presented with potential boundary crossings.
A boundary crossing takes the therapist away from a strictly neutral position, but is not harmful in and of itself. A boundary violation is a boundary crossing that the therapist knows will harm his/her client.

EXAMPLE: hugging a client is generally considered inappropriate. If a therapist hugs his/her client, it is a boundary crossing because it may or may not harm the client.

Question 14

Ethnic-sensitive practice

Answer 14

part of ethics & competent clinical practice. Counselor is ethnic-sensitive when they are aware of their client’s culture & ways in which their culture may affect presentation of symptoms & views of treatments. Counselors are ethically obligated to be competent multiculturally.

EXAMPLE: A Japanese client comes to therapy with a box of traditional Japanese sweets. The therapist accepts the gift knowing that gift giving is customary in Japanese culture and refusing the gift is a sign of disrespect that may harm the therapeutic relationship

Question 15

Legal aspects of informed consent

needs better ex

Answer 15

the person giving consent must have the capacity to give consent, comprehension of relevant information, and the consent must be given in a voluntary nature without coercion. A person has the capacity to give consent if of age and sound mind, meaning they are not under the influence and they are permitted to make decisions for themselves. Comprehension of relevant information refers to the participant’s ability to understand what you’re telling them (pay attention to mental status/competence; language barriers).

EXAMPLE: An adult consenting to exposure therapy must voluntarily come to therapy, must understand how therapy will be carried out and what the justification is for the methods, and have the capacity to make decisions for him or herself.

Question 16

Licensure vs certification

Answer 16

Certification is given by a group of professionals to a member of their profession based on their performance. Licensure is required by law and is given by a government-controlled board. License holders are monitored by a governing body. Licenses are usually awarded after a multitude of requirements are met, typically including schooling, testing, and internship hours. Certification is usually voluntary, while licensure is required by law. Certification is going above and beyond licensure requirements. Certification does not have a governing body, and usually has minimal requirements to obtain, such as a course on the material.

EXAMPLE: One day I hope to be a licensed professional counselor which requires a master’s degree in counseling, a certain number of internship hours, and passing whatever exam the state I live in requires. I would also love to obtain a certification in addictions counseling

Question 17

Malpractice

Answer 17

a form of civil law whereby parties who are injured in professional relationship may seek compensation for damages. These behaviors may include 4 D’s: Duty or missed professional responsibility (missed obligation to client); Damage to the client on behalf of therapist’s actions; Deviation from typical practice standards; and there must be a Direct relationship between damage and deviation (causation)

EXAMPLE: Therapists making inappropriate advances on patients can be sued in a malpractice suit.

Question 18

Mens Rea

Answer 18

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?

EXAMPLE: You were called as an expert witness to discuss mens rea as it relates to a crime that was committed by a group of teeneagers involved in pranking/bullying another child. Child killed themselves and now the kids are being charged with manslaughter. The question you are tasked with answering is: Was it their intent when they were bullying to cause the person to kill themselves?

Question 19

Morality

Answer 19

Individual’s internal value system for what is right & wrong & what constitutes right & 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: A therapist believes that cheating on your girlfriend is wrong, but does not judge his client for cheating or try to convince him not to do it. The therapist recognizes that him viewing cheating as wrong is part of his morals. The client does not necessarily share these morals.

Question 20

Peer consultation

Answer 20

Ethical clinical practice. Process whereby a counselor consults with professional peers about clients & treatments they’re considering. Consultation allows counselors to ascertain that their biases are not influencing their decisions. It is important that the professional maintains the client’s confidentiality by giving only pertinent details of the case and no identifying information about the client to the consulted professional. Consultation is ESSENTIAL when using a risk management model and practicing ethically.

EXAMPLE: Carly was seeing a client who was showing signs of a dissociative disorder. Although Carly was trained to handle these disorders, it was her first time treating one on her own, so she chose to use peer consultation with several other therapists to check and see if the treatment she was considering was the standard of care for dissociation.

Question 21

Privileged communication

Answer 21

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.

EXAMPLE: Patient tells you in session about the 50 pounds of marijuana she has in her basement. This is considered privileged communication and is protected by law

Question 22

Pro Bono services

Answer 22

part of ethics & clinical practice. 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, & 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 client came to Tim in need of therapy but could not afford to pay for it. Tim offered to provide four sessions free of charge to the client in the form of pro bono service.

Question 23

Professionalism

Answer 23

Clinical Practice. How a professional presents themselves. Aspects of professionalism include appropriate dress & proper behavior when interacting with a client, & appropriate behavior when in the community. One may be unprofessional without necessarily being unethical, but frequently the two are tied together.

EXAMPLE: Cindy, an LPC, went out to a bar one night and became significantly intoxicated. She ran into a client and proceeded to dance and fraternize with them in a way that did not reflect professionalism and was also unethical, as she was crossing boundaries, which could be harmful to the therapeutic relationship

Question 24

Reporting child abuse

Answer 24

Counselors are mandated reporters of child abuse–one of few situations in which confidentiality may, & must, be breached. Reports must be made within 24 hours or one business day. Clinicians must report neglect or abuse of the elderly, the mentally handicapped, or anyone else that is vulnerable.

EXAMPLE: Eric, a 9 year old, came to see his therapist and had suspicious bruises all over his body. When the therapist asked him about them, Eric seemed distraught but would not say where they came from. The therapist brought it to the attention of Eric’s mother, who also refused to talk about it. The therapist informed the mother that he had a mandated responsibility to report child abuse, and when the mother stormed out, he called DSS.

Question 25

SAD persons

Answer 25

psychological assessment tool used to assess suicidality and the main factors associated with suicidal behavior.
General assessment to determine the risk of suicide in a client.
Sex: Men
Age: 15-24, males 75+, females 45-54, 65+
Depression: hopelessness
Prior History: attempts
Ethanol Abuse: alcohol/drugs
Rational Thinking Loss: psychosis
Support System Loss
Organized Plan
No Significant Other
Sickness: in self or significant others
Rating scale: 1 point each
0-2 keep watch
3-4 send home; call often
5-6 consider hospitalization
7-10 hospitalize

EXAMPLE: You’re assessing suicidality in a pt of yours that has bipolar. She has attempted suicide in the past. She and her boyfriend just broke up. She is 46 years old. Using the SAD PERSONS assessment, you find out she scores 4 points because she has prior history, she’s experiencing support system loss, she is at a high-risk age for suicidality in women, and she has no significant other. You decide to send her home after she contracts for safety and call her often to check in.

Question 26

Self Monitoring of ethical practice

Answer 26

part of Ethical clinical practice. 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 & reviews. Relying solely on self-monitoring could result in rationalization & justification for unethical behaviors

EXAMPLE: Mary and her husband, Joe, run a counseling practice together, and have for years been conducting a therapy known as conversion therapy to try to transform homosexuals into heterosexuals. Because they have been relying too much on self-monitoring of ethical practice instead of consultations and supervisions with other peers, they have rationalized their use of this therapy, despite the fact that it is potentially harmful.

Question 27

Sexual intimacies with former clients

Answer 27

Ethics, Law & clinical practice. 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 “just say no.” 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: Bruce ran into a former client, Cherie, three years after terminating therapy, and found her attractive. However, Bruce knew that Cherie had some tendencies towards borderline personality disorder, and decided that being sexually intimate with her could be harmful.

Question 28

Treatment of minors

Answer 28

part of Ethics, Law, and clinical practice. 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.

EXAMPLE: A thirteen year old showed up at Teresa’s office asking for an appointment. After establishing that the child was not in crisis, Teresa explained that she could not see him without his parent’s consent, and gently suggested ways that he might talk to his parents about coming to therapy

Question 29

Tarasoff case

Answer 29

Mental health law. 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; psychologist has a duty to warn/protect, which led to 1976 Tarasoff decision. 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: Billy, an unstable individual whose therapist suspects of having a personality disorder, came in for a session and told the therapist he was planning on killing his wife that night. Due to the precedent established by the Tarasoff case, in addition to reporting the threat to authorities, the therapist had a duty to warn and protect the third party.

Question 30

Values in counseling

Answer 30

beliefs & attitudes that provide direction for everyday living. Counselor should be careful not to impose their values on their clients, but instead to respect their client’s personal values system.

EXAMPLE: Pamela was providing therapy for a 25 year old single, pregnant woman who was trying to decide whether to have the child or not. Pamela found herself almost discouraging the woman from having the baby. She realized that she was imposing her values (“unwed mothers are immoral”) on her client.

Question 31

Vicarious liability

Answer 31

Legal in context of supervisor/supervisee relationship. Supervisor is vicariously liable and legally responsible for any mistakes that their trainees make in their practice. Despite the fact that it is the trainee’s mistake, the supervisor assumes responsibility for it when they become supervisor of that individual.

EXAMPLE: Ned is supervising a trainee who makes a mistake by agreeing to go on a date with a client who they claim is not severe and “could handle it”. Because Ned is supervising the trainee, he is vicariously liable for this mistake and any consequences resulting from the trainee’s decisions.