PSYC-514 Ethics and Professional Issues in Counseling

Question 1

SAD PERSONS scale

Answer 1

A form of suicide assessment, this describes the characteristics of a person with increased suicide risk. These include 
Sex, 
Age, 
Depression, 
Previous attempts, 
Ethanol (alcohol) Abuse, 
Rational thinking loss,
Social supports lacking, 
Organized plan, 
No significant other,
Sickness.

An example would be if a client who was a 55 year old gentleman with previous episodes of depression came into a session for alcohol abuse, he may need to be monitored for suicidal tendencies more often as he meets at least 4 or more increased risk characteristics.

Question 2

Assent vs Consent to Treatment

Answer 2

Assent is a term used to express willingness to participate in treatment or research by persons who are by definition too young to give informed consent (under 18) but who are old enough to understand the proposed treatment or research.

Informed consent is still needed, however, and can be obtained from the legal guardian. Consent is the voluntary agreement of an individual, or their authorized representative, who has the legal capacity to give consent, and who exercises free power of choice, without any other form of constraint or coercion to participate.

An example would be a 14 year old assents, or agrees to participate in treatment, but his parents signed the paperwork and legally consent for him to attend treatment.

Question 3

Bartering of Clinical Services

Answer 3

Bartering is the acceptance of goods, services, or other non-monetary payment from clients/patients in return for psychological services. Psychologists may barter only if (1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative. This should be something with a value already placed on it, and should be avoided when possible.

An example would be allowing someone who works in a painting business paint the office (which is in need of paint) for psychological services.

Question 4

Basic purpose of ethical practice

Answer 4

To safeguard the welfare and safety of your clients, while minimizing the risk to the therapist. This is done by following professional ethics codes that utilize the guiding principles of beneficence, justice, non-maleficence, and autonomy. This allows us to function in a way that is consistent with the discipline, focused on patients, and aims towards aspiration.

An example of this would be making the decision that it is the best and most ethical treatment plan to differ the client to another therapist who is better suited for their needs, personality, or otherwise.

Question 5

Certification

Answer 5

This is different than licensure. When certified, no governing body is overseeing the people who have the certification. There is training associated with receiving a certification, which is usually done in a course.

An example would be taking a course to be certified in a technique such as EMDR. This includes training and requirements to be met but a board does not oversee a licensing process.

Question 6

Confidentiality

Answer 6

The most important part of the therapeutic alliance. There is a primary obligation to protect the privacy of information received in the professional relationship with client and take reasonable precautions to protect private information obtained through or stored in any medium. It is important to mention to the client that there are exceptions to confidentiality; harm to self or others, a court order, or if they (or an authorized guardian depending on age) request their own records.

An example would be not acknowledging a client if seen in public, until they talk to you first, in order to protect their confidentiality that they attend therapy.

Question 7

Confidentiality in Group or marital counseling

Answer 7

This tends to be harder to maintain than individual therapy, due to the group clients not being bound to confidentiality as the therapist is. Confidentiality is within the group, but cannot be controlled by the therapist outside of the sessions.
In marital counseling, the therapist needs to make it clear there are no secrets and anything told to the therapist without the spouse in the room will be told to the absent spouse. This limits the risk for any favoritism of the therapist to be assumed. Establishing parameters on confidentiality is key.

An example would be if a couple came in for marital therapy and one partner told the therapist he still has an on going affair that he did not intend to stop, the therapist would have to disclose this to the other partner, due to having no secrets and to avoid the affect it could have on future sessions.

Question 8

Counselor competency

Answer 8

Having adequate or better ability to perform some task physically, emotionally, or otherwise. Practicing without this or above one’s level or scope is unethical. Events or stressors in a therapist’s/clinician’s life may impair the counselor’s abilities.

An example would be a therapist struggling with alcohol/drug abuse is not competent to offer services. Additionally, a therapist trained in individual CBT is not competent to offer services to families as a Bowen family therapist.

Question 9

Direct liability

Answer 9

Therapist is directly responsible for their conduct; liability falls under their license.

An example would be if a client entered a session stating suicidal ideation, but didn’t contract for safety and was allowed to go home and completed suicide. The following investigation suggested there was only one practitioner working with the client, that practitioner would have direct liability for the client.

Question 10

Dual/Multiple relationships

Answer 10

Having a professional and other relationship with the person outside of the office (not always avoidable). This should be avoided as the dual relationship could alter the underlying structure of the therapeutic relationship or disrupt the objectivity of the therapist. When unavoidable, there needs to be clear communication and transparency in order to maintain boundaries and the integrity of the therapeutic relationship. If this integrity is lost, termination or referral would need to take place.

An example would be if a close friend of mine has a child who is beginning to act out in school, and she asked me to counsel him to see what’s going on. I would not be able to because of close/frequent contact in a different role and would refer her to someone else.

Question 11

Duty to warn/protect

Answer 11

Occurs when confidentiality has to be broken in order to protect either the client from themselves or someone the client is planning on hurting. This is based on the Tarasoff case. This should only be done if there is an identifiable victim, they are in imminent danger (it will happen soon) and there is probable risk (there is a high likelyhood everything is in place for it to be carried out.)

An example would be if the client is planning on killing their sister, and he has the means and a specific plan for that night, the therapist should commit the client, inform the police, and inform the sister.

Question 12

Empirically-supported treatments

Answer 12

Treatments that have been shown to be efficacious through research.

Criteria for EST - met stringent scientific criteria: 1) at least 2 randomized controlled trials (RCT) comparing treatment to placebo and/or established treatment, a large # of single case experimental design studies, or meta-analysis; 2) well-defined treatment protocol that can be independently replicated usually following a manual; 3) independent investigators reach similar conclusions; form basis of evidence based practice

Question 13

Ethics **

Answer 13

Standards that govern the conduct of professional members. They are guided by the code of ethics.
Conflicts may arise in areas where codes, laws, values, morals don’t align or conflict.

An example would be the APA code of ethics to hold members accountable.

Question 14

Ethical Boundaries in Clinical Practice

Answer 14

Limits to the therapist-patient alliance. Crossing these boundaries can have positive or negative consequences; must follow the codes with regards to boundaries, but also use clinical intuition/judgment when presented with potential boundary crossings.

An example would be having a social or otherwise intimate relationship with a client. Should strive to keep the relationship professional between therapist and client, as to not compromise confidentiality of the client or the objectivity of the therapist.

Question 15

Ethnic-sensitive practice

Answer 15

Being aware of the different backgrounds of clients and being aware of multiculturalism; acknowledging there are differences between cultures, practices, religions, and worldview that may come into play during or throughout therapy.

An example would be 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 and may harm the therapeutic relationship

Question 16

Legal aspects of Informed Consent

Answer 16

There are three aspects to informed consent; comprehension, capacity, and voluntary. The client must meet all three of these aspects in order for them to consent to research or therapy. Voluntary refers to the client not feeling forced or coerced to consent in any way. Comprehension refers to the client’s ability to understand what they are signing, in terms of reading levels, language barriers, etc, as well as what they are participating in. Capacity refers to ability to legally be able to make decisions for themselves, and this can encompass age and mental health, amongst other things.

(1) disclosure of information, (2) competency of the patient (or surrogate) to make a decision, and (3) voluntary nature of the decision.

Question 17

Licensure vs. Certification

Answer 17

Members with a license have their actions monitored by a governing body. This is usually awarded after a multitude of requirements are ment, typically including schooling, testing, and internship hours. Generally in professions with licensure, it is illegal to offer services without a license. Certification does not have a governing body, and usually has minimal requirements to obtain it, such as a course on the material.

An example would be the difference between gaining licensure to become a therapist (which includes a masters, 750 hrs of internship, testing, and 2000 more hours of internship) and becoming first aid certificed (A 4-8 hour course).

Question 18

Malpractice

Answer 18

A form of civil law whereby parties who are injured in professional relationship may seek compensation for damages. These behaviors may include duty (a missed obligation to the client), damage to the client due to the therapist’s actions, a deviation from the therapist’s standard practice, and there must be a direct link between the damage to the patient and the therapist’s behavior.

An example would be if a therapist deviated from his normal practice, and traumatized the patient during therapy, the client can sue for damages.

Question 19

Morality

Answer 19

Perspectives of right and proper conduct and involves evaluation of actions on the basis of a broader cultural context or religions standards.

An example would bemoral obligation to tell truth, etc.

Question 20

Peer consultation

Answer 20

Occurs when a professional talks with another professional in order to obtain guidance on what to do in a new or tough situation with a client. 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.

An example would be if a therapist noticed a change in the client’s diet, or an increased obsession with food, they should consult with a colleague who specializes in eating disorders in order to get an accurate view of the client’s case, only disclosing the eating schedule and new behaviors.

Question 21

Privileged communication

Answer 21

What is talked about is protected by law due to the nature of the relationship, and does not have to be disclosed in a court of law if they do not wish to disclose it. This is for medical professionals, religious leaders, and spouses. Patient owns record but we own privilege, our only defense in a court case.

An example would be if a man who was attending anger management therapy was on trial for assault and his therapist was called to the stand, the therapist does not have to talk about anything his client said or what they talked about outside of what is in his notes, due to privileged communication.

Question 22

Pro Bono service

Answer 22

Professional work undertaken voluntarily and without payment or at a reduced fee as a public service; provide services to those who are unable to afford them. It is important to establish boundaries and avoid allowing either party to take advantage of the situation. counselors are highly encouraged and sometimes required per ethical mandate to make a reasonable effort to contribute to society through pro bono work, which can be done by devoting a portion of professional activities such as speaking to groups, sharing professional information, and offering reduced fees, with little to no financial return.

An example would be if a college student needed help with a recent death of a family member but couldn’t afford sessions, a therapist could work with them for a set amount of sessions for no fee, or pro bono.

Question 23

Mens Rea

Answer 23

a legal phrase used to describe the mental state a person must be in while committing a crime for it to be intentional. It can refer to a general intent to break the law or a specific, premeditated plan to commit a particular offense.

Paranoid schizophrenic not taking his medication, hurts someone due to delusions, when brought to court, mens rea is addressed, or his state of mind while committing the act.

Question 24

Professionalism

Answer 24

Refers to how the person presents themselves including appropriate dress as well as behaviors, for at therapist may include skills such as WEG and nonjudgmental listening, and prompt and clear communication with clients. One maybe unprofessional without necessarily being unethical, but frequently the two are tied together.

An example would be The therapist demonstrated his professionalism in the way in which he conducted his therapy practice. He was always prepared when clients arrived, was dressed appropriately, treated clients with respect, and returned phone calls within 24 hours.

Question 25

Reporting child abuse

Answer 25

Child abuse is physical or psychological harm to a child with visible, lingering marks, or alters their behavior. This includes neglect. Medical professionals are mandated reporters, meaning they have an obligation to make reports if they suspect any abuse, even if it is only a suspicion and done in good faith. Medical professionals should err on the side of reporting, and are protected from civil liability. If a report isn’t made, the consequences could be a lost license and 6 months in jail. It is important to know normal milestones and not pathologize normal behavior.

An example would be if a child came into session with oversexualized behavior, bed wetting issues, and is afraid to be alone with her dad, the therapist should make a report due to her behavior changes.

Question 26

Self-monitoring of ethical practice

Answer 26

Monitoring your own actions and work levels in order to help clients to the best of you ability. This includes knowing the apa codes and keeping track of behaviors which may prevent you from meeting these codes. Essentially anything impacting the therapist from performing their work-related activities in a competent manner. This includes knowing you skill set, your mental health, any possible substance abuse issues, or other behaviors which distract from the client.

An example would be if a therapist seeking consultation due to their grieving for a family member, which is disrupting their work and taking focus away from the client.

Question 27

Sexual intimacies with former clients

Answer 27

Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. If it does occur, the therapist has the burden to prove there was no coercion or anything occurring during therapy, and often depends on the type of therapy given.

An example would be if a therapist ran into a client a few years after the cessation of therapy at a public place, and they decide to start dating.

Question 28

Tarasoff case

Answer 28

This case spurred the creation of Duty to Warn law. It occurred in California, when a client, Poddar, told his therapist about his plan to kill a girl on campus, Tatiana Tarasoff. Poddar was detained for a period by Campus police, and then released, but Tarasoff was never advised of the threat due to confidentiality. Poddar later killed Tarasoff in the manner he described to his therapist. This should only be done if there is an identifiable victim, they are in immediate danger (it will happen soon) and there is probable risk (there is a high likelyhood everything is in place for it to be carried out.)

To make report:
Probable risk
Special relationship exists (between person and therapist)
Identifiable victim
(Can include groups in some states)
Imminent danger

An example would be If a client expresses the desire to hurt/harm his wife and has the ability and means, it is the therapist’s responsibility to notify the client’s wife and the police.

Question 29

Treatment of minors

Answer 29

In the context of clinical practice, parental consent (preferable from both parents), is required for the treatment of individuals under the age of 16, although these individuals should be given the opportunity to assent to treatment if it is age appropriate. Parents therefore have the right to the child’s record unless they sign a waiver giving up that right. There are two exceptions; in emergency situations treatment may be administered, and if the minor is married they are treated as a consenting adult. Clinicians must be cautious treating minors when they are brought to therapy by only one parent, that this may be a noncustodial parent who may not have the right to submit the child for treatment. It is important to act in the best interest of the child, regardless of the referral source. Be aware of possible alternate agendas which could have sent the child to treatment.

Question 30

Values in counseling

Answer 30

In the context of clinical practice, values are beliefs and attitudes that provide direction for everyday living. These personal views do not dictate whether you are practicing ethically and may not align with ethical standards and should not be blended into your treatment if they conflict with ethical standards. A counselor should not impose their personal values on a client but instead respect their client’s value system.

Question 31

Vicarious liability

Answer 31

Vicarious liability

Question 32

HIPAA compliance

Answer 32

HIPAA Compliance is the process by which covered entities need to protect and secure a patient’s healthcare data or Protected Health Information.

Ex. Not taking pictures of children in facility