Law and Ethics Exam

License and registrations have to include

full name, number, complete title or Abv- PCCI when spelled out on the same page

consequences for engaging in sexual relations with clients

guilty of sexual exploitation, misdemeanor, prison and a fine, second offense is a felony

When others consent to minors treatment: record access?

has the right to records, may not disclose if it has detrimental effects on the wellbeing of the minor

Covered entities (HIPPAA)

health care providers, health care plans, counseling, mental health furnishes, bills, or is paid for health care in a regular course of business

Client receiving counseling from another professional

if they are working on a different problem, release form to consult, collaborative work,

mandated reporters immunity

immunity from criminal and civil liability for making a report authorized even when abuse was acquired outside of professional capacity or scope of employment, UNLESS PROVEN THAT THE REPORTER KNEW IT WAS FALSE

Abuse that MUST be reported?

- Physical abuse= injury or death inflicted by other than accidental (DOES NOT INCLUDE ABUSE BETWEEN MINORS OR PEACE OFFICER) -Sexual abuse= sexual assault or exploitation,rape, statutory rape, rape in concert, incest, child molestation, selling/distributing pornographic material with a minor, employing a minor to perform obscene acts, pregnancy of a minor DOES NOT constitute reasonable suspicion of sexual abuse

Can or cannot consent? - Minors parents divorce and one has sole custody

- Sole parent consents only

When duty to protect does not apply

- Someone other than the client is the dangerous party (ONLY WHEN COUNSELOR'S CLIENT REPORTS THREAT) encourage the client to report the third party themselves, counselor would have to get consent to contact the police - If a third party (NOT IMMEDIATE FAMILY) tells counselor that client is going to hurt someone, check with client to determine if it is true -No reasonable identifiable victim (counselor does not have to know the victims name!!!!!), client seems dangerous but no identifiable victim NO DUTY TO WARN but may want to initiate a 5150 -Client threatens suicide, no duty to protect (contact parents, 5150, or appropriate action

Supervisor requirements

- current CA license for at least 2 years - 2 years experience -supervision training -not related to intern -complete responsibility statement -no more than 3 interns

Can or cannot consent? -Parents are unmarried

- if paternity is not a dispute, either parent can give consent, court necessary if disagree, if paternity not established, mother give consent only

emancipation from court when

1. 14 2. in their best interest 3. financially stable 4. income isn't criminal

Inactive license status

- pay a biennial fee with 1/2 renewal fee and is exempt from CEU's -reactivate license= pay other 1/2, 36 CEU's (if more than a year expired), and 18 CEU's (if less than a year expired)

When counselor is mandated to make a report of child abuse:

- within scope of employment and professional capacity, -has knowledge of or suspects child abuse, -WITHIN 36 HOURS telephone or written report, - 2 or more mandated reports do not have to report the same case -Learn about child abuse from a third party in a professional capacity they MUST REPORT

Unemancipated minor consent to treatment

- 12+ mature enough to consent - shall include parents (unless involvement is inappropriate) document! -minor's parent is not liable for payment unless parent participates

Involuntary treatment=

-harm to self/others -grave disability/alcoholism/mental disorder -refuses voluntary

Can or cannot consent? -stepparent

-not unless they adopt parent

Exceptions to privilege

1. Client waves it 2. counselor is legally mandated 3. client has disclosed significant part of info to third person 4. or one of the situations that are exceptions: patient-litigant exception, crime or tort, breach of duty arising out of psychotherapist-pt relationship, patient is dangerous to self, others, property, patient is under 16 is victim of crime

Diverse populations keep in mind:

1. Communicate appropriately 2. no discrimination 3. culturally sensitive when diagnosing (culture and economic status) 4. Address biases 5. Asses instruments are culturally sensitive

Sets for ethical and legal dilemmas

1. Describe parameters 2. determine what issues are involved 3. consult guidelines and laws for each issue 4. identify alternative solutions 5. consider consequences of each alternative 6. choose course of action

When confidentiality MUST be breached (MUST BE!)

1. Duty to warn/protect 2. Child abuse (under 18) 3. Elder/dependent adult abuse

Holder of privilege

1. Patient 2. Guardian or conservator of the patient 3. Personal representative if the patient is dead - Counselor cannot testify if privilege is not waived or court decides its an exception

Patient Rights

1. Right to inspect and receive a copy of their PHI, Pt cannot obtain info when Phi was obtained by someone other than the provider under the promise of confidentiality 2. Right to amend their PHI-request an amendment 3. Right to receive an accounting of disclosures of their PHI- to third parties made during a 6 year period prior to request 4. Right to request restrictions on disclosures of their PHI 5. Right to request confidential communications- request to speak within them in a certain way (phone or send mail to post office ) 6. Right to receive a notice of privacy practices- note of their rights prior to treatment (NOT a substitute for informed consent)

Conditions of informed consent

1. capacity- pt must be able to make rational decisions 2. comprehension- understand information 3. Voluntariness- give consent freely

When confidentiality MAY be breached (MAY BE)

1. certain types of child/elder abuse (emotional damage or at risk of suffering emotional damage) 2. Danger to self/others 3. Disclosure to health care providers, plans, professionals, facilities (common practice to provide auth but not required)

Responding to subpoena (steps)

1. determine if it is legally valid 2. respond REQUIRED (get clients auth, if client does not give auth then you can negotiate with the party, you can send a letter to the court asking to modify supoena, only give relevant information if ordered by court) 3. Do not provide confidential information unless order by the court 4. When issued to provide testimony or produce documents, you must comply with the order * it is illegal to tamper with notes or records to avoid disclosure

ethical violations of colleagues? actions you take?

1. encourage counselor first 2. Formal report to state or national board 3. always take into consideration client confidentiality

emancipated minor can consent to:

1. medical 2. dental 2. psych care

What is addressed in the informed consent

1. nature of services 2. changing roles 3. Distance counseling 4. when the treatment involves a team 5. explain the nature of assessment 6. forensic setting 7. supervision 8. research, risks and benefits, can always withdrawal their participation 9. fees 10. license 11. telehealth- must get verbal consent

NO REQUIRED to report elder or dependent adult abuse when they are told of the abuse BUT:

1. no corroborating evidence 2. victim has dementia or medal illness 3. based on clinical judgement, has a reason not to believe that it happened

advertising

1. testimonials- no 2. using training to sell products- no (may sell textbook) 3. professional qualifications accurately

Minors get emancipated by:

1. valid marriage 2. active duty with military 3. declaration of emancipation from court

Insurance fraud includes

1. waiving copayments 2. inaccurate diagnosis 3. billing for missed appointments 4. filing as individual when its a couple/family 5. couples therapy and billing both 6. someone else sign insurance claim form

5250

14 day hold after 5150, danger to self/others, alcoholism, grave disabled

Minor sexual intercourse rules

14 to consent, report if 14 with a younger, 14 and 21 report, 15 and 22 report

License renewal steps

24 months after issue date, renewal application to BBS, if not, fee will be paid and license will expire

Supervision requirements

3,000 hours supervised work experience post-degree no more that 5 hours of supervision can be counted (2 hours of group or 1 individual is a unit) Cannot be independent contractors (employees or volunteers ONLY) done in 6 years or less

Minor involuntary treatment 5585

5585 hold, auth from parents unless unavailable, 72 hours, gravely disabled, hurt self/others,

License LPCC mandatory courses-

6 hours CE course on L&E during each renewal and one time 7 hour CE course on HIV/AIDS prior to initial license renewal

Elder and dependent abuse

65+, dependent is 18-64 who lives in CA and has disabilities due to age that limit them taking care of self or in a 24-hour health facility -physcial abuse, abandonment, isolation, financial abuse, or neglect

keeping of records for how long

7 years or 7 years after client is 18

Question 44: A therapist is also a supervisor at an agency in a small town. One of his private practice clients has applied to be an intern at the agency. The agency does not employ any other supervisors that can supervise the intern. The client pleads to get the intern position in that agency since there are no other agencies in town. He mentions that it is a far drive to another town with a different agency that he might be interested in. What action should the therapist take in order to address the ethical issue in the case? Response: A. Explain the ethical conflict and encourage the client to seek internship in another town. B. Work with the man both as his therapist and supervisor. C. Explain the ethical conflict and discuss why the internship is unsuitable for the client. D. Terminate therapy and allow the client to intern at the agency.

A. Rationale: It is an unethical dual relationship to be both therapist and supervisor, so B is out. These are separate and distinct relationships that could lead to exploitation or impair the judgment within the therapeutic relationship. Thus A is the best answer. C is not a good answer, because the internship itself is not unsuitable. If the intern wanted to work with children and this was an internship that only dealt with elder, then the internship would be unsuitable. D would still result in a dual relationship, since within the 2 years of termination we are not able to have relationship with our clients.

Question 67: Two parents bring their 11-year-old son to treatment for ADHD. After a few sessions, the father decides the treatment isn't working and withdraws his consent. The mother asserts that she believes her son needs therapy and that she wants him to continue treatment. Legally, you should: A. Continue treatment, because you only need the mother's consent to treat the child. B. Continue treatment, because the child can consent for his own treatment. C. Stop treatment, because you need consent from both parents to treat the child. D. Stop treatment, because the father has determined the treatment isn't working.

A. Rationale: The therapist only needs consent of one parent when parents are married (A). The child is not old enough to consent to his own treatment (B). The therapist does not need to stop treatment because the father has withdrawn his consent or feels therapy is not working (C and D).

Question 34: A 14-year old comes to therapy telling her therapist she is pregnant with her 17- year-old boyfriend's baby. She is not sure how many months she is. She is scared to tell her parents but is excited about it bringing her closer to her boyfriend. What action should the therapist take to manage the legal and ethical issues? Response: A. Refer the client to appropriate health services and discuss fears about telling parents. B. Invite the family in for a family therapy session to discuss the pregnancy and how they will all handle it. C. Invite the boyfriend in for a couple's session to discuss his feelings and reaction to becoming a father. D. Tell the client that the therapist will have to file a child abuse report due to the differences in age and the sexual interaction.

A. Rationale: The therapist should link the client to medical services and clarify why she doesn't want parent included in order to meet the standard of care in this situation. You don't need to invite anyone else in at this point and the ages of the the minors do not trigger a mandated report.

How long until sexual relationship can happen with client?

ACA Code: 5 years after last professional contact *more stringent!!! B&PC: 2 years after termination

sexual relationship with supervisor, students, or research participants

ARE PROHIBITED

Question 6: A 7-year-old child is referred to the school therapist because he is unable to sit still in class. The child exposes a large, red rash on his torso and complains that the lotion his mom puts on it makes it worse. The therapist calls the mother who shares that she doesn't have time to take her son to the doctor and that she had the same thing as a kid and had to learn to be tough. Ethically the therapist should: Response: A. Inform the mother that she must take the child to the medical doctor. B. Process a possible child neglect report with mother. C. Schedule a meeting with mom and child. D. Schedule an appointment at a community health clinic.

B. Rationale: A is out because that was already done. There is enough here to file a report for medical neglect, so B is the best answer. If the mother understands that there will be a report made she may change her mind. C and D could be done at some point, but the issue of a possible neglect report is the priority.

5.A therapist is pulled over by police after attending a happy hour with work colleagues. The therapist is cited with a DUI. At the conviction hearing the therapist agrees to attend Alcoholics Anonymous meetings. What other legal obligation does the therapist have in this case? A. Inform his clients of his DUI and process their reactions. B. Inform the BBS of his conviction within 30 days of conviction. C. Inform his supervisor of his conviction. D. The therapist has no responsibility due to agreeing to attend Alcoholics Anonymous.

B. Rationale: By law, you must notify the BBS within 30 days of any conviction, name change or address change. We didn't review this in the lectures, you are learning it now.

Question 59: A therapist has been seeing a client for over a year for substance abuse issues and depression. The client arrives for his session visibly drunk, slurred speech, and refuses to sit down on the couch for the session. The client continues to yell at the therapist and tell him he doesn't want to have therapy anymore and starts to leave the office with his car keys in his hand. The therapist legally should respond by: Response: A. Close the door and try to talk the client into sitting down and staying in the office until he sobers up. B. Call 911 and have police help him. C. Call his emergency contact person and let them know what is happening with the client. D. Let the client leave.

B. Rationale: The therapist has a legal obligation to manage safety. Since the client is presenting a danger to self or others due to emotional/mental state, it would be appropriate to break confidentiality and contact police (B). The client is yelling and demonstrating aggressive behavior, so A could endanger therapist and is not required. Reaching out to the emergency contact (C) would not address the immediate danger the client presents, and allowing the client to leave (D) would be ignoring the need to manage his risk to self and others.

Question 37: During an intake assessment with a therapist, a client states that he is angry with his ex-girlfriend who, as he recently found out, cheated on him while they were still together. Upon further exploration, the client reports that he has had serious thoughts about harming her so that she "can't ever hurt me again." To address the legal issues in this case, the therapist should: Response: A. Determine if the client has a history of violence and access to a weapon. B. Explore the nature of his thoughts and determine if he has a plan. C. Warn the ex-girlfriend and notify the police D. Provide a referral to an anger management group.

B. Rationale: The therapist needs to assess potential danger to others and that would start with answer B. Answer A should also be done, but after B. If the client had an imminent plan then C would be triggered. Answer D is an option at some point but shouldn't be done first.

Question 24: A client is the leader of a criminal street gang. He has been seeing a therapist for several years. One day the client shows up to session desperate for a place to hide some guns that could be used as evidence of a gang killing. He brings the guns to the appointment, asking the therapist to conceal them for him. The therapist denies his request. What are the legal issues present in this situation? Response: A. The therapist must report the client to the police. B. This communication between the therapist and the client is not covered by psychotherapist-patient privilege. C. The therapist must assert privilege if the client's records are ordered by the court. D. The therapist must inform the client that he no longer is covered by psychotherapist- patient confidentiality.

B. Rationale: This communication between the client and the therapist is not covered by the psychotherapist-patient privilege, because the client is seeking help to avoid being charged with a crime.

Question 52: A 15-year-old girl is sent to the school therapist because she is upset in class. She shares that her 18-year-old brother was high on crystal meth the night before and hit her multiple times. She adds that she is worried about her 2 year-old brother who is home alone with her brother today. How should the therapist legally manage this situation? Response: A. Report the situation to child protective services immediately. B. Report the situation to the police immediately. C. Create a safety plan for after school. D. Contact the client's parents and inform them of situation.

B. Rationale: Usually CPS is the best answer in child abuse questions. However, you can also report to the police as both agencies cross report child abuse. If given the choice on the exam, you would want to take into account the immediate safety issues. In this case, the young child could be in immediate danger so the police would be the faster response time.

establishing fees

BEGINNING OF THERAPY consider clients financial status and locality, sliding scale when it is fair, when client cannot afford fee the counselor must refer

Confidentiality ethical or legal?

Both, disclose only when appropriate with consent or legal/ethical justification

4. A therapist relocated to another city. Prior to moving, the therapist referred all active clients to appropriate therapists and services. A new therapist of a former client contacts the therapist with a release of information wanting to know about the past treatment and diagnosis of the client. This particular client had multiple suicide attempts and a history of substance use. The therapist should: Response: A. Only answer the new therapist's questions. B. Contact the client before sharing any information. C. Answer the new therapist's questions and include information about suicide and substance history. D. Contact the client after sharing the information.

C Rationale: Due to the crisis issues that the client is dealing with C is the best answer. It is best practice for the continuity of care to collaborate with the new therapist when client has signed a release of information to do so. If a client has a history of suicide attempts that should be shared.

1. A 67-year-old woman meets with a therapist for the first time. She informs the therapist that her husband is physically abusive toward her and she can't take it anymore. She shares her plan to finally stand up to him by taking a knife and showing him what it feels like to be hurt. She states she has never harmed him before. How should the therapist manage the legal obligations in this case? A. Create a safety plan and maintain confidentiality. B. Create a safety plan and report abuse to police. C. Call police to report client's plan and process it with client. D. Call APS and warn her husband of her plan for violence.

C. Call police to report client's plan and process it with client. Rationale: The best answer is C. The client has made a serious threat of physical violence toward her husband, so the therapist's duty to protect/duty to report has been triggered. We cannot maintain confidentiality in this case, so A is eliminated. B does not address the imminent danger at all. This leaves C and D. The first part of D is correct, as elder abuse is present, but notifying the husband of her threat is not clinically appropriate. There is a history of physical violence perpetrated by the husband; sharing this information with the husband could inflame the situation and increase the likelihood of violence between the husband and wife. This leaves C as the best available option.

2. A client reports that she recently awoke in the middle of the night to sounds of crying children in the apartment next door. She went to see if everyone was okay and discovered that the parents had left the 8-year-old, 5-year-old, and 2-year-old home alone. The client suspects that the parents are using drugs and expresses a desire to help the kids. How should the therapist manage the legal obligations? A. Process client's feelings about the situation and document the need to file a report in the file. B. Discuss ways the client could help the kids. C. Inform the client that the therapist must file a child abuse report. D. Determine if the children are in danger.

C. Inform the client that the therapist must file a child abuse report. Rationale: This would trigger a mandated report for neglect so C is the best answer as it manages the legal obligation. There is enough for reasonable suspicion so D is not indicated. A and B could be done at some point but a report has been triggered so that needs to be done first.

Question 68: Your client is a 35-year old woman that you have seen for two sessions. She came to see you to work through relationship issues with her husband, and at the third session she tells you that he finally has agreed to participate in couple's counseling. Ethically, you should: Response: A. Refer the couple to another therapist, while you continue to treat the wife as an individual. B. Obtain informed consent from the husband, review issues related to confidentiality, and proceed to treat the couple. C. Discuss the potential risks and benefits of changing the unit of treatment, obtain informed consent from the husband, and proceed to treat the couple. D. Continue to treat the wife individually, while simultaneously providing the couple with couples counseling.

C. Rationale: Ethically, it is acceptable to change the unit of treatment from an individual to couple or family. However, prior to onset of therapy, the therapist should obtain informed consent from the new unit of treatment. Informed consent should include a discussion regarding potential risks and benefits of changing unit of treatment. It is not necessary to refer out (A) since the wife sought out treatment for relationship issues. While B is not incorrect, discussing the risks and benefits is more important based on the scenario provided. It would not be appropriate to provide individual and couples counseling simultaneously as this would create a conflict (D).

Question 22: A 13-old-girl is referred to therapy by her middle school counselor because she is withdrawn in class and displays signs of anxiety. Her middle-aged mother attends the first session wearing a Muslim headscarf. The therapist is wearing a Jewish Star of David necklace. The mother notices the necklace and inquires whether the therapist is Jewish. How should the therapist manage the ethical issues in this situation? Response: A. Acknowledge the mother's question and remind her that they are there for her daughter. B. Acknowledge the mother's question and provide an honest answer. C. Acknowledge the mother's question and explore its significance. D. Acknowledge the mother's question and remove the necklace.

C. Rationale: The best answer is C. It is important to explore the significance of her question because it will clarify the cultural issues at play for her. All the other answers bypass exploring the significance. B could be done after we explore the significance of the question, but not before.

Question 61: A therapist has been seeing a gay couple who have been attending therapy to deal with the issues behind their family accepting them and also one of the partners being HIV+. The client who is HIV+ calls the therapist distraught and crying and informs her that he has just been told he has full blown AIDS and doesn't want to tell his partner out of fear of upsetting him and scaring him. The therapist should legally: Response: A. Inform the partner of the "no secrets policy" and let him know that it will have to be discussed at the next session. B. Process what it was like for him to discuss it on the phone and let him know he will need to be reported for putting his partner in danger. C. Encourage him to tell his partner and maintain his confidentiality about the issue. D. Bring up the situation in the next session and process with the clients how they are feeling about it.

C. Rationale: Therapists are legally required to maintain confidentiality regarding HIV/AIDS status of a client-this legal requirement takes precedent over a therapist's "no secrets" policy. The best course of action is answer C, maintain confidentiality and encourage the client to disclose the information.

Question 25: A therapist has been seeing a 17-year-old girl for panic attacks who consented for her own treatment because her parents were against therapy. After four sessions the client emails the therapist and informs her that she told her parents about therapy and they no longer want her to attend because they think she doesn't need it. The therapist responds that she thinks the client could still benefit from treatment and she hopes she reconsiders. The client does not respond. How should the therapist manage the ethical obligations in this case? Response: A. Provide client with three referrals. B. Call client to discuss the need for therapy over the phone. C. Document the reason for termination in the client's record. D. Provide client with alternative treatment options for panic disorder.

C.Rationale: The therapist has already reached out via email. At this point, the therapist should respect the client's decision and document termination - answer C. The clientinitiated termination so the therapist does not need to provide three referrals.

Can use what tests? CANT use what?

CAN USE- administer and interpret psychological tests to assess attitudes, abilities, aptitude, achievements, interests, personal characteristics, disabilities, and mental and emotional, and behavioral concerns and development CANT- personality tests, intelligence tests, neuropshychological tests, battery of 3 or more to assess psychosis, dementia, amnesia, cognitive impairment, or criminal bx

Can or cannot consent? Minor has a caregiver

Caregivers who are relatives, 18+, have completed a signed caregivers auth may give consent

Adults who report being abused as children

not required to report, be aware that an adult's abuser may be currently victimizing other children and MUST file a report if reasonable suspicion arises (advise client to report himself, auth)

Question 53: A therapist is meeting with a 68-year-old woman and suspects elder abuse. However, the therapist is not certain if abuse is actually taking place. The therapist is conflicted on whether or not to make a report because it could be detrimental to the relationship with his client. What should the therapist legally and ethically do in this situation? Response: A. Report suspected elder abuse immediately and document it in file. B. Maintain confidentiality and remind client of therapist's reporting responsibilities. C. Maintain confidentiality and document dilemma in file. D. Report suspected elder abuse and process the report with client.

D Rationale: The stem states that the therapist "suspects elder abuse" so the therapist must make a report. The stem also indicates that the therapist is concerned about the impact of the report on therapeutic relationship, so processing it with the client would take priority over documenting the report in the notes. The therapist would document both the report and the conversation with the client once both have been complete. So D is the best answer.

Question 21: A therapist is developing a website to promote his new private practice. All of the following are ethical, except: Response: A. Highlighting the therapist's expertise. B. Providing information about the therapist's training and background. C. Including information about the therapist's office policies. D. Including client success stories.

D. Rationale: In order to maintain confidentiality the therapist would need to ask the client to provide a success story. This is unethical because it is asking a client to do the therapist a favor which could also be seen as misuse of influence and power the therapist has over the clients.

3. A therapist is meeting with high school student who states that he is going to take his father's gun and shoot the members of the football team who are bullying him. He then says that he would not really do it. Legally, what should the therapist do? Response: A. Inform boy's father. B. Maintain confidentiality. C. Inform members of football team. D. Contact police. Rationale: The client states a plan with identifiable victims and he has access to a gun. In this case contacting the police would be the best thing to do even though the client backtracked from his statement. If the client did end up shooting kids at school and the therapist didn't warn police the therapist would be held liable.

D. Contact police Rationale: The client states a plan with identifiable victims and he has access to a gun. In this case contacting the police would be the best thing to do even though the client backtracked from his statement. If the client did end up shooting kids at school and the therapist didn't warn police the therapist would be held liable.

63.A therapist is treating a child whose parents are getting a divorce. The child's mother asks the therapist to do a custody evaluation. The therapist has a history of conducting custody evaluations for the court. How should the therapist manage the ethical issues in this case?Response: A. Conduct the evaluation because it falls within the therapist's scope of competence and the therapist is familiar with the family. B. Conduct the evaluation and discuss the implications of it with both parents. C. Conduct the evaluation only if both parents agree to it and provide transparency regarding the process. D. Decline to provide the evaluation and provide family with referral for a custody evaluation.

D. Rationale: Therapists should avoid providing both treatment and evaluations with clients. In this case, the most appropriate course of action would be answer D, to decline the service and refer the client to an impartial evaluator. While it is within the therapist's scope of competence, providing this service would be a conflict of interest as the therapist already has a therapeutic relationship with the child.

Question 56: A 33 year old woman mentions that the home her grandmother has been staying in has not been answering the phone, when she is able to get through on the phone, they do not put her grandmother on the phone. She complained to the therapist that the last time she went to visit her in the home, her grandmother seems gaunt, distraught and had bed sores that weren't there before. The therapist should ethically respond by: Response: A. Discussing with the client the need to call APS and file a report B. Calling the home during the session with the client to try and assist her with getting on the phone with her grandmother. C. Making a call to a friend who is a therapist at the home and seeing if can check on the client's grandmother. D. Informing the client and discussing with her the feelings around the therapist's need to call the police.

D. Rationale: There is enough to have reasonable suspicion of abuse. In cases where is it a facility, you need to report to the police. D is the best answer because it includes discussing it with the client.

Question 27: During a session, a client informs the therapist that she is concerned for her neighbor who has been behaving strangely since his wife died. The client explains that her neighbor, an elderly man in his 70s, has been doing yard work naked. In addition, the client informs the therapist that she has seen the man foraging in the trash cans and running through the streets shouting profanities. How should the therapist proceed? Response: A. Maintain client's confidentiality. B. Encourage the client to make a report to adult protective services. C. Request client signs a release prior to contacting adult protective services. D. Explain that the therapist must file a report to adult protective services.

D. Rationale: This qualifies as self-neglect and thus warrants a mandated report to adult protective services so D is the best answer.

Can or not consent? Minor in dependency system

Determined by the court (legal or guardians, usually not foster parents)

Can or cannot consent? - Parents share legal custody

Either parent alone, desirable to get both, if one disagrees then consult the court

Can or cannot consent? -Parents are married (bio or adopted)

Either parent alone, when disagree you seek guidance from court

HIV and duty to warn?

GREY AREA, identifiable victim steps: 1. encourage safe-sex refer to a support group, discuss legal consequences (felony) 2. Initiate 5150, if HIV+ is due to a MENTAL DISORDER 3. Explain decision to breach confidentiality to disclose information, attempt to get consent CONSULT

HIPAA's privacy rule

Health Insurance Portability and Accountability Act- to secure patient's health information security rule- security safeguards for electronic PHI transaction rule- required providers who submit certain transactions electronically to use the same electronic format

How and when to make an elder report

In professional scope and capacity observed or has knowledge of an incident, telephone or internet reporting tool immediately, -if by phone, a written report shall be sent WITHIN TWO WORKING DAYS

Penalties for failing to make a report for elderly abuse

In trouble with the BBS, 6 months in jail/1k fine if death, 1 year in jail/ 5k fine

Privilege

LEGAL term referring to a person's rights to not have confidential information revealed in a legal proceeding without permission of the person or their legal rep.

CEU requirements for license

LPCC's must do 36 hours CEUs for each license renewal period (exceptions= living out of the country for a year, military leave, immediate family needs care) -All may be done electronically, half done self-study courses, teaching a course( only once per renewal),

Minor's privilege

Minors in CA hold privilege but parents can waive it, court may waive on their behalf

Referral fees

NO COMMISSION WITH REFERRALS

Crime or tort

NO PRIVILEGE when counselor's services were sought to help a patient plan or commit a crime or escape punishment for a crime

When there is a elderly abuse internet reporting tool, Written report is....

NOT REQUIRED IN ADDITION to internet reporting tool

Question 38: A new client shares that he is also a therapist. He discloses that he recently had an affair with a client, but ended it because he knew it was wrong. He indicates feelings of guilt and remorse. How should the therapist proceed considering the legal and ethical issues in the case? Response: A. Explore his feelings of guilt and remorse. B. Provide him with the brochure "Professional Therapy Never Includes Sex." C. Encourage him to file a report with the BBS. D. Find out if this has happened with other clients.

Rationale: A is the best answer, there is no obligation to report this or investigate it. At this point your primary concern is to provide therapy to your client regarding this issue. B is done when a client has revealed they had inappropriate relations with a therapist when they were their client.

Abuse that MUST be reported with Elders

Physical, abandonment, abduction, isolation, financial abuse, neglect,

Question 8: During an initial assessment with a 7-year-old boy, a therapist observes that the boy is small in stature and appears listless and gaunt. He is difficult to engage in play and mostly unresponsive to questions about school and friends. The therapist notices that the boy is trying to sneak candy from a dish into his pockets. What should the therapist do to legally handle this situation? Response: A. Comment on the child's behavior. B. Call in the boy's mother to tell her about the behavior. C. Assess for further signs of child neglect. D. Make a note of the behavior and intervene if it is repeated.

Rationale: The question stem hints at possible neglect. There is not enough to make a report, but there is enough to indicate assessing further so C is the best answer.

Question 14: A 13-year-old client with anxiety returns to therapy after a month at summer camp in Nevada. The client reports that his camp counselor exposed himself to the kids in his cabin and fondled the client at night. The client does not want his parents to know about the incident because he is ashamed that he "let it happen" and knows his parents will be angry with him. How should the therapist legally handle his disclosure? Response: A. Assure him that his parents will understand and need to be told. B. File a report with Nevada Child Protective Services. C. File a report with California Child Protective Services. D. Obtain a release to contact the camp and inform them of allegations.

Rationale: A child abuse report must be filed because child abuse occurred and it must be filed in California because that is where the therapist is licensed to practice so C is the correct answer.

Question 11: A 29-year-old female client is referred to therapy by her MD for postpartum depression. She shares that she self-medicated in the past with marijuana and that her newborn had a positive toxicology test at birth. Her doctor recently prescribed antidepressants but the client does not think they are working. What are the therapist's legal obligations in this case? Response: A. Report the positive toxicology report to CPS and document it in the record. B. Obtain a signed release to contact MD and assess for risk. C. Refer client to a substance abuse treatment center for an assessment. D. Obtain a signed release to contact husband and MD.

Rationale: According to California law, a positive toxicology test at birth is not in and of itself enough to trigger a report, so answer A is incorrect. B is the best answer because you need a signed release to contact MD, which you would want to do in this case in order to coordinate care. Assessing for risk is also important because she is coming in with postpartum depression and reporting that the meds aren't working. C is wrong because there is no clear reason to refer to treatment at this time. D is wrong because there is no indication of there being a husband.

Question 55: A therapist lives and works in a small community. A woman that he dated intimately over eleven years ago gets in touch with him and is seeking therapy. She has recently broken up with her husband and is needing therapy to resolve her issues regarding her divorce. The therapist ethically should respond by: Response: A. Referring the client to another therapist due to the conflict of interest. B. Begin therapy with the client since it was over two years that they had a sexual relationship. C. Refer the client to another therapist due to the dual relationship. D. Receive consultation on the situation and make a decision based on what the colleague suggests.

Rationale: Answer A is the best because this is a case where there could be a conflict of interest due to a prior romantic relationship. Conflicts of interest occur when there are circumstances that make it hard for the therapist to be impartial. This is a better answer than C because it is more specific to the case at hand and at this point there wouldn't be a dual relationship.

Question 70: You are treating a 28-year-old client with Borderline Personality Disorder and a history of previous suicide attempts. During one session, she tells you that she frequently argues with her boyfriend, and during the arguments she often threatens to commit suicide to punish him for disagreeing with her. You ask her if she has a plan to kill herself, and she just laughs and refuses to answer your question. You should: Response: A. Continue trying to assess the client for suicide risk, even though she refused to answer your question. B. Review your "no suicide" contract with the client and ask her to sign it. C. Discuss the possibility of voluntary hospitalization with the client. D. Continue treating the client according to the treatment plan, and reassess for suicide risk at a later time.

Rationale: Answer A is the best option. The client has a history of suicide attempts and has indicated potential risk. Although the client is being evasive, the therapist should continue to assess and manage the risk to determine if other interventions would be necessary. If the therapist determined a high risk, then C could be considered. Asking client to sign "no suicide" contract could be part of assessment, but is not sufficient on its own. Answer D does not address the immediate risk.

Question 69: A client is being treated by you for generalized anxiety disorder, and discloses after a few sessions that she is also seeing another therapist at school for treatment for a social phobia. The client signs a release, and during your conversation with the other therapist, you agree that she will continue to treat the client for social phobia, while you continue to treat the client for generalized anxiety disorder. This decision is: Response: A. Ethical, because both therapists are treating the client for distinct, unrelated problems. B. Ethical, because the client has made an informed choice to work with two separate therapists for her problems. C. Unethical, because the client's problems are too closely related to each other to be treated separately. D. Unethical, because the client hasn't signed a consent form agreeing to receive concurrent treatment from two different therapists.

Rationale: Answer C is best. It is unethical to treat a client who is receiving similar services from another therapist. In this case, generalized anxiety and social phobias are too similar and would result in duplicate services.

Question 71: How long must you legally retain records for a minor client? Response: A. Seven years from the beginning of treatment. B. Seven years from the end of treatment. C. Seven years after the client turns 18. D. Seven years after the client turns 25.

Rationale: Answer C is correct. Legally, therapists must retain records for 7 years following termination and for minors 7 years after the minor turns 18. B is incorrect, because it is not accurate with minors.

Question 26: A therapist in a family service agency is working with an 8-year-old girl who discloses in session that she was sexually molested by an older boy at school. As she is talking, the therapist realizes that the boy is in a therapy group that she facilitates at the school. The therapist should NEXT: Response: A. Obtain more specific details about the abuse. B. Question the other client about the allegation after the next group. C. Report the abuse to the appropriate authorities. D. Contact the school principal to report the abuse.

Rationale: Answer C is correct. There is enough for reasonable suspicion so a report is required.

Question 62: A therapist has opened her own practice after spending many years as an event planner for weddings and parties. One of her newer clients expressed concerns that her upcoming wedding planning is costing her fiancee and the client a lot of money and they are looking for the best locations and vendors to use for the wedding. The therapist knows many people in town that offer lower pricing. The therapist ethically should: Response: A. Give a list of vendors the client should use so her anxiety levels can go down. B. Contact her friend who is a florist and give her the client's info her for her contact with a flower quote. C. Do not mention the fact that she was a wedding planner and give assistance because it is out of the scope of practice. D. Do not help the client since it is out of the Scope of Competence.

Rationale: Answer C is the best choice. The therapist would be acting outside of her scope of practice by providing advice on wedding planning to the client. While the therapist has a background in wedding planning, she should only provide services that fall within her scope of practice--providing psychotherapy and related referrals.

Question 73: A client comes to therapy to process the ending of his marriage. He and his wife are currently engaged in a custody battle over their three young children. The client asks you not to bill his insurance for his therapy, and requests that you not keep any records of his sessions. He states that he doesn't want a paper trail that could be subpoenaed and used against him in court. What is your legal obligation in this case? Response: A. Agree that you won't keep session records, because the client has a right to confidentiality. B. Agree that you won't keep session records, because HIPAA doesn't require you to keep them unless you are billing his insurance. C. Inform the client that you are required to keep session records, and provide him with information on the type of information you will be documenting. D. Inform the client that you are required to keep session records, and reassure him that his record is confidential and can't be accessed by the courts.

Rationale: Answer C is the best option. Therapists must maintain treatment records and failure to do would be falling below the standard of care. Answer D is incorrect because we cannot guarantee his records would remain confidential.

Question 16: During a family therapy session, the therapist notices that both the 6-year-old and the 4-year-old children have bandages on their hands. The mother discloses tearfully that she can't trust her 16-year-old stepson to stay alone with her young children because he superglued their hands to his door. The husband shakes his head and says, "We already dealt with this. It won't happen again." How should the therapist clinically manage the legal issues in the case? Response: A. Find out how they dealt with it. B. Document the incident in the notes. C. Inform the family that the therapist must file a child abuse report. D. Ask if other incidents like this have happened before.

Rationale: Answer C is the correct answer because this situation would require a mandated report as the older child is much older and it was not mutual fighting. The children were clearly injured from the incident so there is enough reasonable suspicion of abuse. Informing the family would be the correct way to clinically manage the situation.

Question 75: A 13-year-old girl is brought into therapy by her parents for symptoms of depression. She shares with the therapist that she is questioning her sexuality, and feels no one will accept her for who she is. She repeats statements about wanting the pain to go away and describes a plan to take her parent's sleeping pills that evening and "never have to face the pain and loneliness again." The client has made a prior suicide attempt. Which of the following actions should the therapist take to address the legal obligation in this case? Response: A. Maintain confidentiality and make a contract with the client to prevent a suicide attempt. B. Break confidentiality and notify the client's parents of her comments about dying. C. Maintain confidentiality and provide the client with a suicide prevention hotline number. D. Break confidentiality and initiate an evaluation for hospitalization.

Rationale: Answer D is the best option. The severity of symptoms and past suicide attempts make an evaluation for hospitalization the best option due to high risk. Answers A and B do not adequately address the risk. We may choose to break confidentiality and inform parents, but answer B does not adequately address the concerns--only informing parents of comment about dying and not plan or means.

Question 12: A therapist is referred a woman who was recently discharged from a short-term stay in a mental hospital following a manic episode. The woman is living with her parents and is being seen monthly for medication monitoring by a psychiatrist. Legally, the therapist should: Response: A. Request to meet with client's family to gather additional information. B. Obtain signed consent to speak with client's psychiatrist. C. Ask client to sign a no harm contract. D. Identify treatment goals that the client should focus on.

Rationale: B is the best answer in order to provide the best care for this client. At this time, the clinician should consult with the psychiatrist. This provides continuity of care coming out of hospitalization and gives the therapist important information regarding medication. It is also the only "legally required" answer. A and D are possible interventions for later. C is out because there is no indication that the client is intending to harm herself.

Question 66: You are a therapist working in a facility for mentally disabled adults. During a session, you notice that one of your clients has a bruise on her arm. You ask her how she received it, and she tells you that she bumped her arm on a door while she was walking with assistance into her room. You review her chart and determine that the staff member who was with her followed the correct procedures for providing assistance to a resident while walking. What is your legal obligation in this case? Response: A. Report the injury to Adult Protective Services, because a dependent adult was injured in a care facility. B. Report the injury to law enforcement, because a dependent adult was injured in a care facility. C. Document the incident in your notes, but take no other action because the injury was accidental. D. Document the incident in your notes, and report the injury to your local ombudsman.

Rationale: Based on the information provided in the question stem, there is no indication of abuse, thus the therapist should not make a report (A, B, and D). Ethically, the therapist should document the incident and rationale for not reporting and maintain confidentiality, answer C.

Question 54: A therapist begins treatment with a couple. During the intake, the wife discloses that her husband can get very angry and hit her while the children are around. She also mentioned that their 9-year-old son has tried to protect his mother and get in between the husband and wife causing the son to get hurt at times. The therapist hasn't experienced many domestic violence clients in his time as a therapist and is feeling unsure of how to handle working with this couple. He should legally respond by: Response: A. Referring the husband to an anger management group and creating a safety plan with the wife and son if it happens again. B. Consulting with supervisor or colleague that specializes in domestic violence work. C. Call CPS and make a mandated report for the abuse the son encountered and process it with parents. D. Continue to see the couple as long as they sign a no harm contract.

Rationale: Because the child has been hurt during their fights, a CPS report is mandated. So C is the best answer to your legal requirements. B would be important regarding scope of competence issues - but that is an ethical issue.

Question 49: A 38-year-old woman with Borderline Personality Disorder continually engages in scapegoating during a weekly treatment group. After consultation, the therapist facilitating the group decides to dismiss the client from the group due to the destructive nature of her in-group behaviors. How should the therapist ethically manage the client's termination from group? Response: A. Inform the client during a group session that she will be leaving the group in 2 weeks. B. Ask the group whether the client should be dismissed from the group. C. Schedule an individual appointment with the client to discuss the decision. D. Refer the client for individual treatment before termination is discussed.

Rationale: C is the best answer because this is a matter that should be handled privately and confidentially. A and B are inappropriate and would clearly shame the client in front of other group members. D could be done as part of the individual appointment, but would not be done FIRST.

Question 51: A 41-year-old female has been in therapy for two years for anxiety attacks and depression. She is no longer taking medication and is currently symptom free. During recent therapy sessions she frequently laughs and enjoys herself. Which of the following actions should the therapist take to address the ethical issues in this case? Response: A. Interpret the client's behavior as a flight into good health. B. Confront the client regarding avoidance of underlying issues. C. Develop a termination plan with the client to maintain progress made. D. Identify precipitating events leading to the new symptom development.

Rationale: C is the best answer. Since the goals of therapy have been met it is ethical for the therapist to discuss termination and begin that process. A is a strange interpretation of the behavior. B may not be true for the client.

Question 47: A bilingual therapist working at a community clinic has met with a client for three sessions. During the fourth session the therapist determines that it is necessary to initiate a 5150 because the client presents as a serious danger to himself. After informing the client of the need to initiate a 5150, he becomes agitated and demands to see the clinic's interpreter, stating the therapist must have misunderstood him. The interpreter meets with the client and reports finding no reason the client should be hospitalized. How should the therapist manage the legal issues in this case? Response: A. Follow the advice of the interpreter and not initiate a 5150. B. Explain the concerns to the interpreter. C. Meet with the client and the interpreter to reassess. D. Initiate a 5150.

Rationale: C is the best answer. The interpreter is not a trained professional to assess for suicidality. Therefore, the therapist needs to conduct the assessment and the interpreter is there as a means for the therapist to have clarity in communicating with the client. Initiating 5150 is a serious matter, that takes someone's freedom away. So before doing D we need to be certain that there is a good reason for it.

Question 45: All of the following are true about authorizations for release of information EXCEPT: Response: A. It must have the current date. B. It must have an end date. C. It must indicate who will be sharing information with whom. D. It must be written in 12-point font or larger.

Rationale: D is correct. The releases must be written in 14-point or larger.

Question 42: A therapist meets with an 80-year-old man and his son. The son would like the father to move out of his home and into an assisted living facility. He shares that he lives alone, has fallen twice, and he is concerned for his safety. The father disagrees and would like to stay in his home. The son wants the therapist to convince the father that moving would be in his best interest. How should the therapist ethically manage the issues presented? Response: A. Discuss the importance of self-determination with the son and his father and provide a referral for home assistance services. B. Explore the risks of the father staying in his home and his fears of assisted living. C. Discuss the pros and cons of assisted living facilities. D. Assess for potential self-neglect and discuss expectations of treatment.

Rationale: D is the best answer. You would want to assess for self-neglect right away as that is a key part of any decision going forward. Expectations for treatment are also important and this would be important to clarify when there are competing ideas of what need to happen. Answer A seems to push to support the dad's wishes. B states the dad has "fears" of assisted living, which isn't in stem. C does not address potential self-neglect at home.

Question 35: A therapist is treating a 68 year-old woman following the death of her spouse. The patient has no immediate family and reports having been financially exploited by acquaintances following the spouse's death. In order to address the legal issues in this case, the therapist should: Response: A. Interview the client regarding the specifics of the alleged exploitation. B. Call APS immediately and file a written report of elder abuse within 24 hours. C. Seek legal assistance concerning the financial exploitation. D. Call APS immediately and file a written report of elder abuse within 2 days.

Rationale: Financial abuse of an elder is a mandated report so you are picking between B and D. The correct time line for a written report is 2 days so D is the best answer.

18.A therapist begins an assessment with a mother and her 13-year-old son. During the course of the assessment, the therapist learns that the mother has previously used a belt to discipline the son for breaking curfew. The mother and son insist that a child abuse report has already been filed and that Child Protective Services (CPS) has closed their case. How should the therapist legally and ethically respond?Response: A. Elicit information from the mother regarding referrals made during contact with CPS. B. Contact CPS to ensure that a report has already been made, and if not, make the report. C. Explore how the mother and son are handling disciplinary situations now. D. Help the mother and son process the emotional after effects of CPS involvement.

Rationale: If a client discloses abuse and reports that it has already gone through CPS, the therapist must confirm that the report was already made or file it him/herself. Each new incident of abuse must be filed even if the client is already in the system.

Question 10: During a therapy session, an 18-year-old client reports that he assaulted his neighbor's son whom he suspects broke into the client's car and stole his radio. The client is bragging and showing no remorse. What action should the therapist take to manage the legal responsibilities in this case? Response: A. File a child abuse report and process it with client. B. Determine the age of the victim and file a report if necessary. C. Maintain confidentiality and document incident in record. D. Identify alternative coping skills and role play in session.

Rationale: If the victim is a minor, then the therapist is mandated to file a child abuse report so B is the best answer. A and C would depend on the age of the child. D could be done at a later time.

Question 57: A therapist has been seeing a client for a few months when the client has been put under a 72 hour hold with a 5150 by his psychiatrist. The therapist is not sure of the reasonings behind the 5150 and would like to find out more about what is happening with his client. The therapist legally can respond by: Response: A. Calling the client's mother to find out what happened. B. Contacting the psychiatrist treating the client in the hospital to discuss the reasons the client is there and the treatment the client is receiving. C. Not speaking to anyone since the therapist does not have a release from the client to do so. D. Faxing the client a release form at the hospital so the psychiatrist can be spoken to.

Rationale: In a crisis situation like this, the therapist should do option B. The psychiatrist would have the responsibility of releasing the information since there is a danger issue with a client and it is important that the care is coordinated in the hospital.

Question 9: A therapist receives a call from a local hospital. The therapist's client has been hospitalized following a psychotic episode. The hospital psychologist requests information regarding the client's history and diagnosis. How should the therapist legally respond to the request for information? Response: A. Release the information due to the crisis situation. B. Speak with client to receive consent to share information. C. Obtain a signed release from client. D. Refuse request to protect client's confidentiality.

Rationale: In a situation of crisis, the therapist may provide information needed to treat the client without their consent so A is the best answer.

Question 46: A Hmong couple are referred to therapy by their children's school. Their 6-year- old daughter has been sick recently and the school is concerned that the parents are not getting adequate health care. The parents share that they immigrated here five years ago. The therapist knows very little about the Hmong culture. Ethically, the therapist should: Response: A. Research Hmong culture. B. Ask the couple to talk about their culture and their immigration story. C. Encourage the couple to tell her about their culture and how it may be impacting the current situation. D. Consult with a therapist who is an expert on the Hmong culture.

Rationale: It is best to get cultural information directly from the couple since they have their own unique experiences within the culture that they are a part of. Therefore, answer C is the best answer. In addition, it builds therapeutic rapport with the clients.

Question 48: A therapist admits to an intimate relationship with one of his clients whom he has treated for over two years. The therapist is the subject of regulatory board investigation. He tells the investigator that he truly loves this client and would like to marry her. When interviewed, the client reports that she initiated the sexual contact with the therapist. The therapist terminated therapy with the client when she moved in with him. The therapist's actions are: Response: A. Acceptable because the client initiated the relationship. B. Legal but unethical. C. Acceptable because the therapeutic relationship was terminated. D. Illegal and unethical.

Rationale: It is both illegal and unethical to have intimate relations with a client, even if it is client initiated.

Question 13: A therapist in private practice works predominantly with adolescents and uses text messaging to remind them of upcoming appointments. The therapist accidently sends a message to a client that was intended for her son that says, "I love you." How should the therapist ethically manage the situation? Response: A. Acknowledge mistake and discuss the boundary violation. B. Explore the impact of texting on the therapeutic relationship. C. Stop using text messaging in clinical practice. D. Send a follow-up text apologizing for the mixup.

Rationale: Many of these answers sound okay. The best answer is A because it includes discussing the boundary violation. Even though it was a text sent to the wrong person, it still included the client into the therapist's personal relationship. B, C, and D, could all be done as well, but A should certainly be done after such mishap.

Question 40: Which of the following would be considered poor clinical boundaries? Response: A. A therapist goes to lunch with a client with an eating disorder. B. A therapist visits a client in the hospital after a suicide attempt. C. A therapist brings a child with attachment issues to her home for a play therapy session. D. A therapist goes to the grocery store with a client with agoraphobia.

Rationale: Of all the answers, C is the one that shows poor clinical boundaries because it has the client coming to the therapist's personal residence and doesn't seem clinically appropriate. A, B, and D all seem clinically appropriate.

Question 58: A 13-year-old girl would like to seek therapy for issues going on at school and at home. Her mother has brought her to the initial session since she would like her daughter to have therapy. Her husband, the client's father, thinks therapy is a waste of time and money and doesn't want her to be in therapy. Legally, the therapist should: Response: A. Have the teenager sign her own consent for treatment. B. Have a family therapy session to discuss the father's concerns and views on therapy. C. Have the mother sign consent for the client to receive therapy. D. Refuse to see the client until the father signs the consent as well.

Rationale: Since the parents are married, only one parent needs to sign consent, making answer C the correct choice. There is no indication it would be inappropriate to involve the mother, so the teen should not sign consent (A). B is not necessary, since the mother may consent and D is incorrect since it is not legally required.

Question 74: A licensed therapist with a thriving private practice is diagnosed with cancer. The therapist learns from her doctor that she will need to stop working for three months so that she can complete chemotherapy, beginning one month from now. What ethical obligations does the therapist have in this case? Response: A. Prepare a professional will, notify clients of her upcoming absence, discuss the options for continuing treatment with each client individually. B. Avoid burdening clients with her personal health information and refer all of clients out to other therapists so they can continue treatment uninterrupted. C. Prepare a professional will, inform clients of her diagnosis, and discuss the options for continuing treatment with each client individually. D. Inform clients of her diagnosis, discuss the options for continuing treatment with each client individually, and transfer all records to another therapist for safekeeping.

Rationale: The best answer is A. Answer A addresses the need for a therapist to develop a professional will and provide continuity of care during an absence. Answer B is too drastic, it is not necessary to refer clients out and it would be inappropriate to share your health information with clients, C and D.

Question 17: A therapist runs an anger management group at a community mental health agency. A group member meets with the therapist individually, to complain that another group member shared confidential information outside of the group. Ethically, how should the therapist manage the situation? Response: A. Encourage the client to address concerns during the next group session.. B. Address the issue with the other group member at next group session. C. Remind group members of the importance of maintaining confidentiality. D. Meet with the offending group member and discuss concerns.

Rationale: The best answer is A. Like couple's therapy, you want to direct the person to bring the issue up in the group session. As the leader you would help facilitate that discussion but you would not want to be the one who brings it up as it would indicate that the leader has had outside discussions with a group member. You could also do C as part of the discussion, but you would want to start with A

Question 65: A therapist has been treating a high-conflict unmarried couple for five months. The couple decides that they are going to break up and they terminate couple's therapy. A week after termination, the girlfriend contacts the therapist and requests individual therapy.The therapist agrees to treat girlfriend. After a month of therapy with the girlfriend, the boyfriend contacts the therapist and requests individual therapy as well. How should the therapist manage the ethical issues in this case?Response: A. Provide the boyfriend with a referral to another qualified therapist. B. Inform the boyfriend that it would be a conflict of interest to treat him because of the previous couple's therapy. C. Inform the boyfriend that it would be a conflict of interest to treat him because the girlfriend is currently in individual treatment. D. Agree to treat the boyfriend because you agreed to treat girlfriend.

Rationale: The best answer is A. Providing individual therapy to both the boyfriend and girlfriend would create a conflict of interest. Since the therapist is already seeing the girlfriend for individual therapy, it would be best to provide boyfriend with a referral to another therapist (A). The conflict is not due to seeing them as a couple (B), it is because the therapist is already treating the girlfriend and (C) would be breaking confidentiality.

Question 31: A client mentions she has been having a difficult time with anxiety and depression since she began a lawsuit against the company that fired her. She discussed feeling anxious about how they will treat her as a witness in the trial and who else they may end up wanting to bring into the court for the case. The therapist was subpoenaed by the client's opposing lawyer. The therapist should legally respond by: Response: A. Asserting privilege. B. Consulting with a lawyer regarding the subpoena. C. Turning over the client's record and whatever else is required within the subpoena. D. Maintaining confidentiality.

Rationale: The best answer is A. There is no option of informing the client, so the best thing to do would be to assert privilege.

Question 72: A therapist has been treating a new client for depression for three months. During her session she reports she is going on vacation for a month. She states that she wants to continue treatment while she is away, and asks to continue treatment through the use of phone sessions. Legally, what is your responsibility? Response: A. Verify that she is staying in California and inform her that you can't treat her if she leaves the state. B. Complete a separate informed consent for tele-therapy with her, and agree to provide phone sessions while she is away. C. Refer her to a local therapist near her vacation residence, so she can continue face-to- face therapy uninterrupted. D. Review the potential risks and benefits of tele-therapy with her, and discuss the possibility of continuing therapy through the use of phone sessions.

Rationale: The best answer is B. Legally, therapists can treat clients who are temporarily traveling, even if out-of-state, but must receive informed consent specific to tele-therapy. If we had an option to contact the state's licensing board to determine regulations regarding teletherapy for out of state clinicians, that would be the best answer, but it is not available to us in this question. It would be illegal to treat a client who is residing in a different state.

Question 28: A 25 year-old-woman is in treatment for Borderline Personality Disorder following a discharge from a psychiatric hospital due to a suicide attempt. The client has a severe trauma history and a deep fear of abandonment. After five months of treatment the client shares that she is dating someone special and wants the therapist to see them for couples therapy to make sure the relationship works out. Offering concurrent couples therapy to this client would be: Response: A. Ethical as long as the risk and benefits are reviews. B. Ethical as long as the expectations of couples therapy are addressed. C. Unethical because concurrent couples therapy is never acceptable. D. Unethical because it is clinically inappropriate with this client.

Rationale: The best answer is D. Ethically you need to consider impact of seeing a client in multiple treatment units and you should only do so if it would not be harmful to client. A client with Borderline Personality Disorder and issues with abandonment would not be a client that should also be seen for couple's therapy because in couple's therapy the therapist needs to be neutral to the individuals in the relationship and that could easily trigger this type of client.

Question 50: A therapist in private practice has a caseload of 15 clients. The therapist is pregnant and is planning on taking at least six months of maternity leave. The therapist is not certain when she will return from her leave. The termination process should include? Response: A. Client's reactions to therapist's pregnancy. B. Client's progress. C. Referrals to other therapists. D. Discussion of return date.

Rationale: The client's reaction to her pregnancy is not relevant to termination so A is not the best answer. C is the best answer because it addresses continued care for the clients in her absence which is directly related to termination. Since the return date is unknown, D is also out.

Question 60: A therapist has been treating an 11-year-old boy for anxiety and depression after the accidental death of his younger sister. After two months of treatment, the boy turns 12 years old. The therapist believes the boy needs two sessions a week due to the severity of his symptoms. How should the therapist manage the legal and ethical issues in this case? Response: A. Obtain a new consent for treatment now that the client is 12 and can consent for his own care. B. Inform the client and parents of the need for additional sessions and document that need and their response in the chart. C. Refer the client to a higher level of care due to the level of risk indicated. D. Contact the client's insurance to see if they will approve additional sessions per your clinical advice.

Rationale: The only answer that addresses legal and ethical responsibilities is answer B. We do not need to obtain a new consent when a minor turns 12 (A). There is nothing in the question stem that points to increased risk or need for higher level of care (C), and there is no indication insurance is being used (D).

Question 15: After meeting with a Japanese-American family for several months, the family has experienced improvements in communication and their children's' behavior has improved. The parents give the therapist a gift card in appreciation of the good work with the family. Ethically, what should you do? Response: A. Acknowledge the parent's appreciation and accept gift. B. Acknowledge the parent's appreciation and decline gift. C. Determine whether "fee for service" is acceptable in area. D. Explore cultural importance of providing gift.

Rationale: The reason B is the best answer is because there is no indication of the cashvalue of the card so the best response would be to decline the card. The other issue here is that, unlike other types of gifts that may have cultural meaning, a gift card is essentially cash. If a client tried to pay you a "bonus" for doing your job, it would be unethical to accept that.

Question 41: A 54-year-old woman, who has been married for 17 years, comes to therapy complaining that her husband has been having an affair for the last several years. She tells the therapist that she and her husband are in couple's therapy together with another therapist, and she would like to start individual work with you as well. How should the therapist ethically manage this situation? Response: A. Obtain a release from her and her husband to speak to her couple's therapist to develop a treatment plan. B. Begin therapy with her immediately. C. Tell her that it is not ethical to see two therapists at the same time. D. Begin therapy with her and obtain a signed release from her to speak to the couple's therapist.

Rationale: The therapies being sought are different in nature therefore it is acceptable to take on this client while she continues to go to couples therapy. It is best practice to include consultation with the other therapist if client is willing to sign a release. D is the best answer. A is wrong because the therapist is treating the woman. The couple's therapist should have them both sign a release.

Question 43: A therapist is measuring the effectiveness of services offered to chronically mentally ill clients at a community clinic. When developing the informed consent for the effectiveness study, the therapist is concerned about the clients' level of competency, which often varies on a daily basis. What should the therapist do to manage the legal and ethical obligation in this case? Response: A. Create a simplified version of the informed consent to ensure understanding. B. Obtain consent only when assured of client's ability to understand. C. Design a rubric to determine various levels of understanding. D. Verbal consent, not written, is sufficient in this situation.

Rationale: The therapist should make an effort to insure understanding. Therefore, since the clients level of competency varies it is best to obtain consent when the client displays a good level of understanding, so B is the best answer. D is incorrect because written informed consent is required for any study. C is unnecessary for the purpose of the question. Answer A is implying changing the consent which should already be presented in understandable language, and the content should not be altered.

Question 64: A therapist begins seeing a new male client. The male client hugs the therapist when he walks in and introduces himself and hugs her when he leaves. The therapist is really uncomfortable with hugs from anyone, especially clients. How should she ethically handle the situation? Response: A. Seek consultation to manage her countertransference. B. Discuss with the client his need or urge to hug and set a boundary with him regarding personal touch. C. Hand the client the "Professional Therapy Never Includes Sex" brochure and discuss that personal touch cannot occur in therapy sessions. D. Continue to allow the client to hug since it is how he manages the relationship..

Rationale: Therapists have an ethical obligation to maintain appropriate boundaries and should explore these issues as they arise, answer B. Consultation is unnecessary, as it is appropriate to set clear boundaries with clients (A). Therapists only need to provide the brochure (C) when a client reveals past indiscretions with therapists, and answer D ignores the boundary issue.

Question 20: A preschool mental health consultant meets with a teacher who is concerned about one of her 4-year-old students. The teacher reports that the child has become increasingly aggressive with peers, has started wetting the bed during naptime, and has come to school with bruises that look like belt marks on the backs of her legs. How should the therapist manage the legal issues in this case? Response: A. Discuss the necessity of reporting the suspected abuse immediately. B. Meet with the child and attempt to clarify the cause for the bruises. C. Call the child's parents to gather more information. D. Make a referral to a pediatrician.

Rationale: There is enough here for reasonable suspicion of child abuse so the best answer is A. The teacher is also a mandated reporter so she may be the one to make the report but the therapist can also make the report. Just because another mandated reporter doesn't make a report doesn't mean a report isn't mandated.

Question 29: A 54-year-old woman seeks therapy for depression. She shares that her 82-year- old mother with dementia moved in with her three months ago and she feels overwhelmed taking care of her. The woman reports, "Sometimes I just leave the house all day, because I can't deal with all her neediness. She's like a whiney baby." What should the therapist do NEXT? Response: A. Refer client to a psychiatrist for medication evaluation. B. File an elder abuse report. C. Determine who is caring for her mother when client is gone all day. D. Refer client to respite care services.

Rationale: There is not enough to file an elder abuse report because there may be someone else caring for the mother while she is out. C is the best answer because it furthers the assessment. Answers A and D could be done at some point.

Question 39: A therapist has been meeting with a client for 7 months with the expressed goal of addressing the client's social anxiety. The therapist has noticed that the initial progress the client was making has slowed and the client might even be regressing, returning to previous behaviors. Ethically, how should the therapist proceed? Response: A. Discuss termination with client. B. Confront client about lack of engagement. C. Consult with colleagues. D. Refer client for psychiatric evaluation.

Rationale: This is a situation where consultation with colleagues is advised. The therapist may need fresh perspective and insight as to why progress seems to be stalling. Therefore C is the best answer.

Question 33: A therapist has been seeing a client for over a year. The client is a sales rep for a major hotel company and travels a lot for work, but always makes time for ongoing therapy focused on her depression and anxiety around being single. During the holiday season, the client gave the therapist a card before leaving for a holiday vacation. In the card was a gift certificate for a weekend stay at the same hotel chain in town including meals. The card said, "Happy Holidays, enjoy some relaxation with my free perks." How should the therapist ethically respond: Response: A. Call the client thanking her for the card and gift and ask her the best way to schedule the reservation. B. Wait until the next session to politely decline the gift and discuss the reasons but also her reaction to that announcement. C. Call the hotel and ask the monetary value of the gift before reserving the room or not using it. D. Consult with a colleague regarding the issue.

Rationale: This is an extravagant gift, even if the client got it for free. The best answer is B - decline gift and discuss with client. There is no need to consult.

Question 32: An 84-year-old client calls her therapist because she cannot make it to the session. She has been financially and physically dependent upon her daughter who moved out unexpectedly last week. Which of the following actions must the therapist take to assist the client? Response: A. Determine alternative support person(s). B. Refer the client to a social services support agency. C. Report possible elder abuse to the appropriate authorities. D. Offer to see the client in her home.

Rationale: This qualifies as abandonment and would require a report so C is the best answer. A, B, and D are all things that could be done at some point but C must be done.

36.A client seeks therapy after the death of her mother. The client shares that her 82 year-old mother was living with her family when she died. The client shares that her mother had dementia and would frequently become verbally and physically aggressive to her and her grown children. She tears up when she reports that she would be so desperate for a break that she'd sometimes lock her mom in her bedroom for an entire day. How should the therapist address the legal issues in this case? A. File an abuse report with Adult Protective Services and document in file. B. Assess for child abuse. C. Acknowledge her feelings of shame. D. Refer her to a grief support group

Rationale: This would be reportable if the mother was still alive, but since she isn't the best answer is C. You could also do D at some point but you'd want to start where the client is.

Question 23: A therapist in private practice meets with a client who is working through issues related to his father's recent death. During one session, the client talks of feeling overwhelmed by his feelings of grief and unable to deal with his own son's crying and sadness about the loss. The client reveals becoming so frustrated with his son over the weekend that he grabbed the child forcefully and left bruises on the child's arm. How should the therapist manage the legal obligations in this case?Response: A. Assess the child. B. Let the client know that the child protection agency must be notified about the incident. C. Educate the client on the stages of grief and provide him with relaxation skills. D. Refer the client to a grief support group.

Rationale: This would require a mandated report, so the best answer is B.

Question 30: A therapist meets with a 45-year-old client who has a history of being violent for an intake assessment. During the intake assessment, the client states that his wife claims to have been visiting family for the past week but he believes she is lying to him. When probed further, he says that he thinks she is actually having an affair with someone. The client says that he plans on hurting her when she gets home so that she doesn't do this again. What action must the therapist take to fulfill legal obligations in this case? Response: A. Suggest other ways to deal with his anger. B. Determine the level of pathological paranoia in the client. C. Inform the police of his statement. D. Discuss the reasons for his suspicions to help the client with reality testing.

Rationale: This would trigger a duty to warn which requires the therapist to contact local police and inform them of the client's statement and history of violence. Answers A, B, and D could also be interventions that could be done but C is legally required.

Question 7: A therapist has been meeting with a client for several months. During a session, the client informs the therapist she is moving out of the area to a different part of the state. She tells the therapist that she doesn't want to find a new therapist and would like to continue by receiving therapy by Skype. How should the therapist legally and ethically respond to the client's request? Response: A. Terminate services and provide three referrals B. Discuss treatment options in the client's new community C. Start internet therapy and obtain informed consent D. Refer patient to providers in her new area

Rationale: You should have gotten it down to B or C. If a therapist is going to engage in teletherapy, they do have a responsibility to be familiar with the available resources for the client in the area they are residing in the event of a crisis. If a client is moving to an area with few services, then teletherapy would be more indicated. However, if a client is moving to an area with an abundance of therapists it would be important to weigh the pros and cons of tele therapy over in-person therapy. Also, C implies that you would start teletherapy right away and it is not clear in the stem when the client is moving.

Question 19: A therapist has been meeting with a client for several months. The client has been using his insurance and is struggling financially after his wife lost her job. He asks the therapist to temporarily waive his co-pay, since he can no longer afford to pay it, and bill insurance for the full fee. The therapist submits the request to the insurance company and they deny the waiver. Ethically, what should the therapist do? Response: A. Agree to waive the copay and continue with therapy. B. Appeal insurance company's denial and continue with therapy while in appeal process. C. Terminate with client due to inability to afford fees. D. Appeal insurance company's denial and discuss fee options.

Rationale: You would want to appeal the decision so that gets it down to B and D. D is better because it would be important to discuss the fee options as soon as possible in the event the insurance denies again.

Court-ordered treatment confidentiality

Still do not disclose information without authorization from client or client's representative, court can order a waiver of confidentiality for court, probation officer, other relevant people

Elder abuse and dependent adult abuse in ANY OTHER LOCATION not: -State mental health hospital, State Development center, Long term care facility

Telephone and written report to: Adult protective services agency or Law enforcement within two working days

in order to see couples and families:

a) 6 semester units or 9 quarter b) at least 500 supervised hours c) at least 6 hours or CEUs in MFT with WITH RENEWAL CYCLE

Elder and dependent adult abuse at a State Mental Health Hospital or State Development center AND -Abuse/neglect resulting in dealth, sexual abuse, assault with deadly weapon by nonresident, injury to genitals, broken bone -All other types of abuse/neglect

abuse/neglect in death, assault, sexual, genitals injury, assault by deadly weapon by nonresident= telephone report to DEPARTMENT OF STATE HOSPITAL OR INVESTIGATORS OF STATE HOSPITAL AND LAW ENFORCEMENT NO LATER THAN 2 HOURS -all other types of abuse/neglect=- telephone and written no later than two hours- report to Department of state, investigators of the state hospital ORRRR Law enforcement

post certification holds

additional days if treatment is neede

5150

adult involuntary hold, 72 hour hold/treatment/eval followed by possible 14 day hold

Unlawful cop oral punishment or injury

any person willfully inflicts upon any child any cruel or inhuman corporal punishment or injury resting in traumatic condition -- does not include force that is reasonable for a person employed or engaged in a school that is disturbing a physical threat or damage to property, self-defense, or obtaining a weapon -not spanking on the buttocks

Consultations confidentiality

avoid disclosing confidential info to consultants that "reasonably could lead to" identification of a client without prior consent of the client, only discuss relevant info for the purpose to consult

Accepting gifts

consider relationship, not monetary, whats the motivation, debate consequences of rejecting gift

Research Confidentiality

counselors should discuss with research participants the limits to the research and implement procedures that protect confidentiality, disguise participants unless they have authorization

Couples and families confidentiality

define who is client, discuss confidentially, document in writing agreement in confidentiality, make apolicy

Counselor providing information outside of scope consequences

denial, suspension, or revocation of license or registration

Penalties for breaching confidentiality

denial, suspension, or revocation of license, misdemeanor punishable by jail 6 months and/or fine not exceeding $2,500

when considering a nonprofessional relationship with client

document extension of relationship and its benefits and anticipated consequences

Tarasoff decision

duty to warn/protect, when client (or immediate family members) communicate serious threat (serious bodily injury) to a identifiable victim

Electronic media confidentiality

emails, voicemails- HIPAA

Abuse that MAY be reported with Elders

emotional well-being is endangered

psychotherapist civil liability

injury due to clients thinking sexual contact is beneficial and part of the treatment

Minor's confidentiality

legally and ethically have confidentiality, all agree to what information breaches confidentiality

Scope of practice

legally defined boundaries of a counselor's professional practice

Scope of competence:

limits of what a counselor is qualified to do (education, training, supervised experience, credentials, and professional experience)

neglect means

maltreatment of a child by a person responsible for the child's welfare (harm for threatened harm to the welfare or health)

telehealth restrictions

must be LICENSED IN CA

unpaid fees steps

must be in informed consent, give reasonable time to pay, send letter, terminate but first notify

Breach of duty arising out of psychotherapist-patient relationship

no privilege when counselor or patient allege a breach of duet arising out of the therapeutic relationship (a client sues counselor for malpractice)

Penalties for not reporting when required for child abuse

no report= 6months jail + $1,000 no report and death= 1 year jail + $5,000

Patient- Litigant exception

patient's emotional condition has been raised as an issue by the patient or representative, employee suing her boss for sexual harassment and patient claims it caused pains attack (info relevant to diagnosis is not privilege)

Assessment- instrument selection, instrument scoring and interpretation, and release of test data

reliable and valid, culturally diverse, client gives auth to have someone qualified to interpret tests

Authorization

required before discloses PHI except with info is being disclosed for routine purposes (billing, treatment, etc), when disclosure is necessary to avert a serious threat to the health or safety of patient/others. Auth includes- 1. description of information to be disclosed, 2. name/function of person 3. expiration date of auth, 4. statement informing patient his/her right to receive copy of auth and to revoke it

Counselor impairment

requires counselors to address when mental illness, physical illness, chemical dependency, or other factor may interfere with the ability to provide ethical treatment

abuse that MAY be reported?

serious emotional damage or risk of damage (anxiety, depression, withdrawal, aggressive bx towards self or others)

severe vs general neglect

severe neglect- malnutrition, medically diagnosed failure to thrive, health is endangered general neglect- failure to provide adequate food, shelter, clothing, medical care, or supervision when no physical injury has occurred

content of client records

specific details are left to discretion of the counselor 1. basic info 2. informed consent 3. relevant history 4. dates/types of services provided 5. assessment/techniques 6. treatment plan with goals 7. progress notes documenting progress 8. sensitive or dangerous topics and alternatives of actions 9. supervision and consultation 10. fees charged and collected

Group therapy confidentiality requirements

stress the importance, express it in prescreening interviews and initial counseling sessions and periodically reminding members

ownership of client records

the organization owns the records while the counselor owns the content of the records

Informed consent

the right of a client to be given adequate information about counseling before making the decision to participate (must be in writing and verbal)

Confidentiality

the right to privacy and refers to obligation to protect clients from unauthorized information disclosure being revealed from a professional relationship (cannot confirm or deny this person is a client)

Minor sexual acts NOT INTERCOURSE rules

under 14 and a 14 year old is reportable, 14 and 24 report, 15 and 25 report

Joint holders of privilege

waiver of privilege from one does not affect the other client's right to claim privilege (with a couple you probably should get both auth) to legally testify

Duty to warn- therapist actions

warn victim AND law enforcement

Bartering

when client suggests it, it does not result in harm, accepted in the community, written clear contract, nothing that can be a negative result

who has access to minor records

whoever has responsibility for minor health care decisions has rights to records

Reporting Elder abuse- Long-term care facility (not state mental health hospital or state developmental center) AND -physical abuse with serious bodily injury -physcial abuse withOUT bodily injury -Physical abuse without bodily injury that is believed to by caused BY a resident with dementia -abuse other than physical abuse

with bodily injury=Telephone report to local law and written report no longer than two hours after hearing of the abuse without bodily injury= telephone call and written report within 24 hours by a resident with dementia= telephone report ASAP and written report to law enforcement within 24 hours other than physical abuse= telephone and written report to law enforcement ***report to local ombudsman, licensing agency, and law enforcement

HIPPA's privacy rule requires counselors to provide

written Notice of Privacy Practices at or before the beginning of treatment that indicates how protected health information will be used and disclosed