Week 4.4. Flashcards
General Principle C: Integrity involves… (7)
Ethical standards on:
- Reputable behaviour
- Communication
- Conflict of Interest/multiple relationships
- Non-exploitation
- Authorship
- Financial arrangements
- Ethics investigations and concerns
You can only breach confidentiality with clients if?
Only can tell others (breach confidentiality) if person makes threat to life or to others
Or mandatory reporting of child abuse
Main idea of General Principle C: Integrity
Professional standard
Financial relationship - paying for service, but shouldn’t be someone employing spouse etc., no sexual relationships,
Case Study 1: Therapist had practised individual psychoanalysis for ten years. After completion of a four-hour continuing education workshop on family therapy, she offered family therapy sessions to some clients while reading books in this field in her spare time
Which of the following was breached:
- Competence
- Confidentiality
- Dual relationships
- Informed consent
- Therapist impairment
Competence
- In this case, therapist did not identify the limit or scope of her practice and training which led to crossing ethical boundaries.
- The case reveals a counsellor lacking in minimum competence levels, training and experience.
- Her efficacy would only come into question if a formal complaint was filed, nonetheless, therapists have an ethical responsibility to practice in specialty areas that are new to them only after obtaining suitable education, training
Need to make sure… (3)
- Make sure training adequate, expert in area, if can’t say that shouldn’t do therapy
- Don’t want inadequate treatment
- Literate clients ask about expertise, is it empirically validated, what are risks
Case Study 2: Therapist F worked full-time at a cancer treatment facility for several years and due to concern for his clients, made himself available “on call” beyond normal hours. His performance lessened after the death of a liked client and a personal marriage concern. F stopped returning calls to clients and staff in a timely way, sometimes missed appointments without giving notice, and exhibited distance from his clients. He was fired by the facility but performed well at his next therapeutic setting.
Which of the following was breached:
- Competence
- Confidentiality
- Dual relationships
- Informed consent
- Therapist impairment
Therapist impairment
- The therapist experienced burnout resulting from stress in the job, personal lives, various client issues dealt with daily, and other factors.
- The therapist was subjected to learned helplessness and depression, in turn, his client was affected.
- Therapist F’s detachment and withdrawal was not professional and would probably negatively impacted on his clients and staff in the cancer clinic.
How many clients can you take a week and why? What is there a requirement to do?
Legal requirements to keep notes
Taking extra people on not advantageous - recommended 21 clients a week
Case Study 3: Client initiates therapy to overcome public-speaking anxiety. Therapist assesses the anxiety results from low self-esteem and treatment targets the delivery of positive reinforcement of client’s positive attributes. After five sessions yielding no change, client conveyed she expected to learn ways to give public presentations without feeling anxious through receiving advice on managing anxiety, reading books on the subject, and practicing speaking with therapist.
Which of the following was breached:
- Competence
- Confidentiality
- Dual relationships
- Informed consent
- Therapist impairment
Informed consent
- This case is not about competence – the therapist made and correct diagnosis and made a legitimate treatment strategy
- However, the therapist is under an ethical obligation to provide relevant information to clients regarding expectations of therapy before onset of treatment.
- Therapists should discuss goals, expectations, procedures, and potential risks of the proposed therapy which would enable the client to make intelligent choices such as whether to receive this particular therapy
What do you need to think about? (3)
- Conflict of expectations
- Need to tell client what their problem is and what you’re attempting to do with the therapy/techniques going to use
- Person knows what’s going on
Case Study 4: Therapist sent a third billing notice to a slow-to-pay client’s fax machine in her office but client did not report to work that day. The bill was titled “psychological services rendered” and handwritten in large print was “Third Notice – OVERDUE!!” with client’s name. This notice sat in an open access mail tray of the busy office all day.
Which of the following was breached:
- Competence
- Confidentiality
- Dual relationships
- Informed consent
- Therapist impairment
Confidentiality
- Therapist should have reasoned that many people have access to the fax machine in a busy place of business.
- Private material should not be faxed unless it is known that the intended recipient will be retrieving the information from a personal machine
Case Study 5: Therapist was attracted to his client of several months and invited her to attend a lecture on eating disorders knowing that client’s sister experienced anorexia nervosa. Client thought it was an appropriate professional invitation, accepted, and then agreed to have dinner after the lecture per therapist’s recommendation. The next session, therapist accepted client’s gift of a book authored by the lecturer from a week earlier. The following week, therapist agreed to a reciprocal dinner at client’s home which culminated in several glasses of wine and a retreat to the bedroom.
Which of the following was breached:
- Competence
- Confidentiality
- Dual relationships
- Informed consent
- Therapist impairment
Dual relationship
- Psychology has a powerful influence people who are vulnerable.
- To ensure therapists set aside their own needs in addressing client needs, the profession has established clear guidelines [also referred to as boundaries] that are designed to protect clients
- In this case, the step-by-step evolution of socialization leading to sexuality is clear in this case and is now problematic regarding therapy whether the sexual relationship lasts or not
Case Study 6: A 13 year-old walks into a Mental Health Centre and asks to talk to someone. Therapist K sees client who indicates many personal and family problems, including severe physical abuse at home. Client asks therapist not to discuss the case with anyone, especially his parents. Therapist explains his options with client, states that he cannot offer treatment to anyone under the age of 18 without parental consent, and expresses his duty to report suspected child abuse to Child Protective Services. Client feels betrayed.
Which of the following was breached:
- Competence
- Confidentiality
- Dual relationships
- Informed consent
- Therapist impairment
Informed consent and Confidentiality
- Therapist K understood that he could not legally accept client’s request for therapy and client could not provide competent informed consent [requirement of a parent or an unbiased third party adult]
- Therapist also failed to explain limits of confidentiality to client from the start in relation to mandatory reporting of suspected child abuse to the proper authorities
What should the psychologist have done?
Should have told client straight away that cannot take people under 13 as client without parental consent.
Case Study 7: Client alleged that psychologist sent copies of his case notes to the insurance carrier responsible for reimbursement and that therapist should not have revealed this information. Client reported psychologist to the APS Ethics Committee. Psychologist explained to Ethics Committee that any client understands that their privacy may be breached when using an insurance company for third-party reimbursement due to administrative and professional peer review. Nonetheless, psychologist never told client of this risk before therapy began, rather, he assumed client “must understand” the protocol.
Which of the following was breached:
- Competence
- Confidentiality
- Dual relationships
- Informed consent
- Therapist impairment
Confidentiality and Informed consent
- The Ethics Committee determined that psychologist violated the confidentiality ethical standard by not providing informed consent to the client of the limits of confidentiality prior to treatment.
- The Committee reprimanded the psychologist and advised him to construct and implement an effective informed consent process for the future - this then would not lead to a breech in confidentiality
What is important to think about with informed consent and clients? (2)
- Shouldn’t assume anything
- Have professional obligation to tell them about everything
