PSYC514 - Ethics

Question 1

SAD PERSONS

Answer 1

A psychological assessment tool used to assess suicidality by looking at the risk factors of suicidal behavior.

Sex: Men 
Age: 15-24, males 75+, females 45-54, 65+
Depression
Prior History
Ethanol abuse
Rational thinking loss (psychosis)
Support system loss
Organized plan
No significant other
Sickness (self or partner)

1 pt for each:
0-2 keep watch
3-4 send home; call often
5-6 consider hospitalization
7-10 hospitalize

Clinical example: Fred is a 77 yr old man being treated for depression. In session, he says he drinks heavily most nights of the week. He says he has thought about suicide, and has pictured shooting himself in the head by his pool with the gun he has. According to the SAD PERSONS assessment, Fred exhibits four risk factors for suicide, meaning he should be sent home but his therapist should call often.

Question 2

Assent v. consent to treatment

Answer 2

Part of: Ethical practice

What: Consent to receiving treatment is given by adults who have reached the legal age of consent (18). Children and adults unable to give consent, provide assent to treatment after the therapist ensures the patient understands the therapy process at developmentally appropriate 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.

Question 3

Confidentiality

Answer 3

The primary responsibility of an ethical practictioner, confidentiality is an obligation to keep information discussed in counseling private. There are three exceptions to confidentiality explained to clients during the informed consent process. Confidentiality is necessary for building a therapeutic relationship. There are three limits to confidentiality: duty to warn or protect, mandated reporting of suspected abuse of a vulnerable population, and a court order.

Clinical example: A therapist learns her patient, a child, is being sexually abused by her father and breaks confidentiality by reporting this to the police.

Question 4

Counselor competency

Answer 4

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.

Clinical example: A therapist working with children should have specific education about child development and psychopathology, and training with supervision, to be a competent counselor for this population.

Question 5

Direct liability

Answer 5

Part of legal and ethical practice.

A counselor is directly liable or legally responsible for any actions they take with a client. In other words, the counselor’s license is what’s at stake when they are delivering therapeutic services.

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.

Question 6

Dual/multiple relationships

Answer 6

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.

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.

Question 7

Duty to warn/protect

Answer 7

Part of ethical practice, the duty to warn one of the rare instances in which a therapist must break confidentiality. Duty to warn means therapists have the responsibility to inform third parties 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 complete suicide is high, the therapist has a duty to protect the client by breaking confidentiality to involve other parties or have the client hospitalized.

Question 8

Ethics

Answer 8

Part of clinical practice, ethics are the standards that govern the conduct of professional members of a group or 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.

Example: The APA code of ethics dictates that therapists must wait two years following the termination of a therapeutic relationship to have a sexual relationship with clients, but it is legal to have a sexual relationship as long as clients have reached the age of consent.

Question 9

Ethical boundaries in clinical practice

Answer 9

Boundaries are a frame that protect the therapeutic relationship in ethical practice. Boundaries may be physical (no physical contact) or behavioral (no gifts, self-disclosure). A boundary-crossing could potentially benefit the client, be neutral, or potentially harm the client. Ethical practitioners use careful judgment when making boundary crossings and only do so when it will benefit the patient. A boundary violation is a boundary-crossing that harms the client.

Example: A therapist agrees to conduct a therapy session while walking because movement helps the client think and dispels some of the client’s anxiety about speaking honestly. This is a boundary crossing that benefits the client.

Question 10

Legal aspects of informed consent

Answer 10

Part of ethical practice, the legal aspects of informed consent are confidentiality, description of services, and fee structure. All of these areas should be outlined in detail on the informed consent document and discussed with the client during the informed consent process.

Clinical example: A new therapist forgets to include her rate, when payment is expected, and whether she bills insurance on her informed consent paperwork. She has not fulfilled the legal requirements of informed consent.

Question 11

Malpractice

Answer 11

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.

Example: Administering a treatment one has not been trained to administer can result in malpractice. For example, if a patient presented with PTSD and a therapist who was not trained in EMDR administered that therapy.

Question 12

Privileged communication

Answer 12

Part of ethical practice, privileged communication 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.

Clinical example: A patient shares with you in session that he was sexually assaulted as a child. That information is privileged and just be kept confidential by the therapist.

Question 13

Professionalism

Answer 13

Part of ethical 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.

Clinical example: A therapist repeatedly shows up to treat patients disheveled and wearing pajamas. While the clinician is not acting unethically, they may be perceived as unprofessional and this could impact their efficacy as a practitioner.

Question 14

Values in counseling

Answer 14

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.

Question 15

Vicarious liability*

Answer 15

Part of ethical and legal practice, a counselor who is in a supervisory role is vicariously liable for any actions taken on behalf of their supervisees with clients. In other words, it is the supervisor’s license at risk when they are training.

Clinical example: Dana is a graduate student completing her practicum at a private practice. The therapist who owns the private practice has vicarious liability for the services Dana provides while working there.

Question 16

Morality

Answer 16

Part of ethical practice, individual’s internal value system for what is right & wrong & what constitutes right & proper conduct. Morals are standards conduct usually guided by a higher authority. In ethical practice, counselors must be careful not to apply their moral code or morality to their clients.

EXAMPLE: A therapist believes that cheating on your girlfriend is morally wrong, but does not judge his client for cheating or try to convince him not to do it. The therapist recognizes that his viewing cheating as wrong is part of his morals. The client does not necessarily share these morals.

Question 17

Peer consultation

Answer 17

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.

Question 18

Bartering of Clinical Services

Answer 18

Part of: Ethical practice

What: bartering refers to exchanging therapy for some non-monetary good or service from a client. Bartering is a boundary violation and should be carefully considered in advance. If a counselor decides to barter, they should draw up a contract detailing the terms of the agreement in advance.

Clinical Example: You are working with a client who loses their job and insurance. They feel it is critical they stay in therapy to help manage the life change, but can no longer afford to pay for your services. They offer to trade lawn care at your office for therapy. You carefully consider and agree to barter for clinical services, and draw up a contract outlining the terms of the trade.

Question 19

Certification

Answer 19

Certification is provided by a professional association or organization indicating an individual has acquired some specialized knowledge or skills in a specific therapeutic modality or population. It is not mandatory to have certification to practice.

Example: You sign up to attend a 3-day training on a specific therapeutic approach for treating trauma: EMDR. Following the training, you are awarded a certificate and have been certified in EMDR.

Question 20

Confidentiality in Group or Marital Counseling

Answer 20

Confidentiality is fundamentally different in group or marital counseling. While the practitioner is still required to keep information shared in session private, the other participants are not required to keep information shared in session private. Therefore, confidentiality can’t be guaranteed.

Clinical Example: During a marital counseling session, a wife reveals she has had an affair with a neighbor. She asks that the information remain private, but the husband reveals her indiscretion to some mutual friends. He is not under the same legal and ethical contract to protect information disclosed in therapy.

Question 21

Empirically-validated Treatments

Answer 21

Treatments that have been empirically demonstrated to be efficacious for a particular disorder or population. They have a well-developed protocol and can be replicated. They must be empirically validated via two independent, placebo-controlled trials, several independent experimental-designed case studies, or a meta-analysis. Using empirically validated treatments is a good ethical practice.

Clinical example: A patient presents with symptoms of obsessive-compulsive disorder. The therapist researches empirically-validated treatments for OCD and recommends exposure with response prevention to her client.

Question 22

Ethnic-Sensitive Practice

Answer 22

Part of ethical practice, an ethnic-sensitive approach or practice is one that considers how the culture of a patient may impact their worldview, attitudes, beliefs, presentation of symptoms, or appropriate treatments. Counselors must be careful and self-aware enough not to apply their own worldview to the clients, but instead, attempt to understand their client’s worldview and the factors that influenced it.

Clinical example: An African-American client presents with fear surrounding social situations, especially in diverse crowds. She feels threatened by strangers and often has panic attacks when in public. A counselor with an ethnic-sensitive practice will dig deep into the origins of this fear to understand if the patients ethnicity and/or past experiences is contributing to the symptoms rather than assuming the patient has faulty beliefs about the world.

Question 23

Licensure v. Certification

Answer 23

Part of ethical practice, licensure is a mandatory requirement to be a legal practitioner and is given out by a government board after rigorous education, training, and supervised practice. Certification is a voluntary process of acquiring knowledge and/or skills typically from a professional organization or association. Typically the requirements for certification are less rigorous than licensure.

Clinical example: Prior to beginning a private practice, Erin attended a graduate program, completed supervised internship hours, and sat for a licensure exam to ensure gained licensure from the South Carolina Board of Licensure and, therefore, be a legal practitioner. She also secured certification in TF-CBT.

Question 24

Pro Bono Service

Answer 24

Part of an ethical practice, pro bono services are when therapists provide service 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.

Clinical example: A therapist in private practice sets aside 3 hours/week to treat patients who are uninsured on a pro bono basis.

Question 25

Reporting Child Abuse

Answer 25

Licensed therapists are mandated reporters and, therefore, required by law to report any suspected cases of child abuse to the proper authorities (DSS and the police). This should be outlined in the informed consent process and discussed with the client when explaining the limits of confidentiality.

Clinical example: A patient reveals that she is worried her boyfriend is touching her children in a sexual way. The therapist is required to break confidentiality and report this suspicion to the proper authorities.

Question 26

Self-monitoring of Ethical Practice

Answer 26

Ethical counselors should be aware of ethical codes and monitor themselves to ensure that they are practicing ethically. However, 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.

Clinical example:

Question 27

Sexual intimacies w/ Former Clients

Answer 27

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.

Question 28

Tarasoff Case

Answer 28

This legal case based on 1970s court case in California after a patient murdered a woman he mentioned harming in therapy. The case determined that therapists have a duty to warn by breaking confidentiality if they suspect a patient intends to harm a named other. They must contact both the authorities as well as the named individual the patient is at risk of harming.

Question 29

Treatment of minors

Answer 29

Part of ethical practice, there are special considerations when treating minors including acquiring assent to treatment from the patient and consent to treat from both parents (except in crisis situations). The parent has the legal right to request and obtain the record of the patient at any time, but the counselor should be wary as it threatens the therapeutic alliance with their patient. Therapists should ensure that the therapy is delivered at an age-appropriate level.

Question 30

Basic Purpose of Ethical Practice

Answer 30

The basic purpose of ethical practice is to protect the well-being of the patient and the public at large by using the guiding principles of ethical practice: beneficence, nonmaleficence, and justice.

Example: Treating a patient with a complex disorder such as schizophrenia when you do not have the training and experience to do so would violate the basic purpose of ethical practice. You are failing to protect the patient by referring them to a clinician who is better equipped to help.

Question 31

Ethnics-sensitive Practice

Answer 31

Part of ethical practice, an ethnic-sensitive approach or practice is one that considers how the culture of a patient may impact their worldview, attitudes, beliefs, presentation of symptoms, or appropriate treatments. Counselors must be careful and self-aware enough not to apply their own worldview to the clients, but instead, attempt to understand their client’s worldview and the factors that influenced it.

Clinical example:

Question 32

Mens Rea

Answer 32

Part of ethical practice, mens rea is 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?

Clinical Example: You were called as an expert witness to discuss mens rea as it relates to a crime that was committed by a woman during a sexual assault. The person accused of assaulting the defendant was killed during the attack. The question you are tasked with answering is: Was it the defendant’s intent to harm the attacker or was she acting in self-defense.

Question 33

HIPPA compliance

Answer 33

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of the U.S. Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of certain health information.

It establishes national standards to protect individuals’ medical records and other personal health information. The Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form.
The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information” (e-PHI). Within HHS, the Office for Civil Rights (OCR) has responsibility for enforcing the Privacy and Security Rules with voluntary compliance activities and civil money penalties.

A therapist must adhere to the HIPAA privacy and security rules in order to protect the information of the patient.