Ethics in Counseling EXAM 2

Court case history of privacy: confidentiality

Caesar v. Mountanos (1976) Hawaii Psychiatric Society v Ariyoshi (1979) Mcintosh v. Milano (1979)- Shaw v Glickman (1980) Lapari (1980) Hamman v County of Maricopa (1987) Little v. All Phoenix South Community Mental Health Center (1995) Jaffee v Redmond***VERY IMPORTANT (1996)

Main ethical issues in Tele-counseling

Competence, informed consent, client verification

Fisher (2009) Protecting Confidentiality Rights

Confidentiality and Client Info Protection Model: 1. Prepare: know clients' rights and your responsibilities. Learn federal and state laws. Clarify your own personal ethical positions. 2. Tell Clients the Truth "Up Front" (Informed consent): Inform clients about limits of confidentiality and potential conflicts of interest. Obtain consent after fully informing them. 3. Obtain Truly Informed Consent to Disclose Voluntarily: Only disclose when legally unavoidable, obtain documented consent before disclosing. 4. Respond Ethically to Legally Imposed Disclosure Situations: notify of client when applicable, check the law and find consultation. 5. Talk about Confidentiality: Model and confront unethical practices. Be the example to follow.

Caesar v. Mountanos (1976)

Courts first upheld that therapist was right not to answer questions although the client had waived privilege. On appeal, court ruled that it was the patient's right to waive or assert privilege.

Privacy

***Freedom of individuals to choose for themselves the time and circumstances under which and the extent to which their beliefs, behaviors, and opinions are to be shared or withheld from others. Word "privacy" is not used, it is inferred. Covered by constitutional law. *Confidentiality has its foundation in the concept of privacy *Privacy has its foundation in the 4th adn 5th amendments of the Bill of Rights of the US Constitution

Informed consent

*A client should understand in advance of counseling the circumstance under which a therapists is required to reveal information to a third party. Informed consent is dynamic. *Informed consent - Four Elements 1. Comprehension - the client is adequately informed and knowledgeable of what is being consented to. 2. Competence - client is competent to understand what is being consented to. 3. Voluntary - the client freely agrees to give consent 4. Written - the informed consent is in writing (documented!)

Confidentiality

*A general standard of professional conduct that obliges a mental health professional not to discuss a client without the client's consent *Implies an implicit contract or promise not to reveal anything about a client except under specific situations *Ethical Standards

Privileged Communication (legal term)

*A legal term describing certain specific types of relationships that enjoy protection from disclosure in legal proceedings *Privilege is granted by law because you are licensed! *Privilege belongs to the client, not counselor

Time after therapy

*APA ethics indicate that at a minimum two years must pass before a therapist can become involved with a client and then only under limited conditions that are clearly documented *ACA ethics indicate that at a min five years must pass

Areas of diversity: ADDRESSING***

*Age* (developmental differences)- people at different stages in life see events and experiences in different ways *Differences in generations*- generations are different from each other due to social, technological, and political occurrences that change an individual's perspective and experience. *Disability* (visible and hidden)- How does this impact and how people see the world? *Religion*- religion privilege occurs and affects individuals. *Ethnicity* (based on culture)- adds certain cultural elements, traditions, and habits associated with that ethnicity and culture. Influences the way we perceive the world as cultural individuals. *Social status* (SES) Think about how this influences clients, how it has evolved and developed in their life and how this impacts their perception of the world. *Sexual orientation* *Indigenous heritage* (native to your area)- where did they grow up, where are they from, what culture did they have and how did that affect their development. *Nationality* (what you put on your passport)- makes a big differences, especially when travelling or in world events. Larger collective identity and what it means to the individual. *Gender* (social/cognitive differences)- where are all socialized to how we behave based on social norms. This is becoming a fluid continuum instead of a binary system as individuals realize they do not fit into either of two categories.

Thought-provoking questions

*Are client journals or diaries confidential? Cases in which they have been used in court *Insurance forms are at risk of being taken and may be used against you, if insurance is through employer they may see insurance forms *Client is not the person who pays the bill, it is the person you see

Dilemma- Sexual attraction

*Attraction between a therapist and client is not the problem per se, but the therapist inappropriately acting on this attraction is. 88% of therapists said they have been attracted and 82% said they would never act on this attraction.

Client attraction to therapist

*Could be issues of client transference or attachment needs *Almost 50% of female therapists have experienced potentially sexualized behavior from male clients *Younger therapists more likely to experience client sexualized behaviors *25% of clients involved with their therapists reported initiating the sexual contact-- NOT an excuse for the sexual relationship *Adult survivors of childhood incest are at the greatest risk for subsequent sexual abuse (sexual relationship) with therapist *Client seductive behavior might be a sign of dependency *Use this info for the therapeutic growth of client *Need to talk about it in a way that protects client's self-esteem and preserves professional boundaries

Business, employing, bartering

*Don't forget fiduciary responsibility, client is always the priority!!! *Terminating therapy to go into business with client- NO!! *Refer employees to someone else for therapy- Lose objectivity, power differential *Don't hire a current or previous client (blurs professional and work boundaries, assumes ownership for client's problem, conflict of interest) *Bartering is not unethical but is risky (exchanging services--equal value and expectations, exchanging goods for services, IRS problems- fair market value of what was received, Insurance coverage)

Legal Sanctions (Sexual MR)

*Felony to have sex with a client in many states- including AZ *Courts rejected client consent as justification *Most insurance companies now limit payment for sexual misconduct and then discontinue therapist

Friendships with clients & Client referrals

*Friendships should begin on equal footing *Power differential *Role expectations *Should you attend client special events? When and why? *Friendship after therapy ends? (risk to client, risk to therapist) ***Any attempt to deflect a role blending with current clients by promising or even hinting at altering these roles after termination instantly alters the current relationship (DON'T DO IT!) *Client referrals- referring a client or terminating therapy in order to start a different relationship. Conflict of interest, threat to confidentiality, professional judgement compromised (CLIENT ABANDONMENT!!)

Safeguards to Minimize Risk of MR

*Get informed consent *Ongoing discussion with professionals of unforeseen problems and conflicts *Consultation *Supervision *Documentation- put dual relationship issues in case notes What you would not want someone to see through a one-way mirror, do not do!!!

Gifts- Giving and Receiving

*Gifts have the power to control, manipulate, or symbolize far more than the recipient may fully understand *Naivete and inexperience are the hallmarks of therapists who accept gifts and favors beyond the small one-time or appropriate special occasion token *Strong professional identity is the key ingredient in dealing appropriately with offer of gifts and favors and understanding the motivation behind this on a case by case basis *Request favor from client only in emergency *Prudent to refrain from giving gifts to clients

Court Case History of Privacy: Cases involving intimate conduct

*Griswald v. Adams (1965) *Eisenstadt v. Baird (1972) Roe v. Wade (1973) Bowers v. Hardwick (1985) John Geddes Lawrence & Tyron Garner v. Texas (2003)

APA Ethical Principles

*Highlight every part of the ethical code that refers to confidentiality and privacy

Sex with Client's significant others

*Impairs objectivity in therapy *Harm to client DON'T DO IT!

Risks to Professionals in MR

*Loss of credibility *Violation of ethical standards *Revocation of license *Role conflicts *Impaired clinical judgements *Exploitation of client *Inaccurate case notes *Legal prohibitions *Failure to seek consultation or supervision Males more likely than females to mix roles and more likely to have sexual contact with clients

Role as a Therapist (preventing MR)

*Multiple relationships can occur when the therapist uses their clients/patients for their own gratification- getting their own (not the clients') needs met *Meet client needs by matching therapeutic style/theory and techniques with client needs NOT TO MATCH YOURS *Clear and consistent boundaries help to prevent multiple relationships

Touching

*Non-erotic touching- -very brief touching of client had, back, or shoulders could convey caring and support -almost 90% of therapists do not do more than shake a client's hand as a form of touch -hugging done more by females and males (ask why you feel the need to hug) -kissing- DON'T- slippery slope according to Freud

Sexual Dual Relationships (Stats)

*One of the two most frequently violate ethical standards for APA and for ACA *Survey of APA members in 1994 revealed that 88% reported being sexually attracted to a client and over 59% reported seeking consultation about this attraction *Almost half of all therapists have become sexually aroused during therapy *Male therapists, 2-12% have had sexual dual relationships *Female therapists, 0-3% have had sexual dual relationships *Koocher and Keith-Spiegel (2008) state that the rate of sexual impropriety is between 5% and 6% overall *Pope claims that 5% of cases involved minors

Factors of Potential for Harm to Client in MR

*Potential for harm ALWAYS exists *Major problem in potential EXPLOITATION of client (student, etc.)- Power Differential, Loss of objectivity *Factors influencing potential for exploitation and harm: -incompatibility of expectations -divergence of responsibility -power influence and prestige of the profession -distortion of natural boundaries of therapeutic relationship -effects client cognitive processes -therapeutic objectivity compromised -client is objectified -integrity of therapist compromised

Perpetrators of sexual relations with clients

*Primarily male therapists in 40s and 50s *Over 80% involved with only one client *May fear intimacy *Have troubled personal relationships *Have high need for love or affection, power, positive regard *Have poor impulse control *Are socially isolated and isolated from peers *Overvaluation of ability to heal *Poor sexual identity and other unresolved conflicts *Depressed, bipolar, narcissistic, sadistic, or other character or predatory psychopathology *Most claim to be ignorant of ethics

Plan for Therapist Death: Professional Living Will

*Professional executor- handles office logistics, confidentiality, notifications, and legal issues. Should be another mental health professional. *Clients/patients- when should they be told? who should tell clients? Funerals and/or other rituals for deceased? Should this be part of informed consent? (YES!) *Disposal of client records Living will --> a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. For psychologists/counselors, they are specific instructions regarding notifying clients, client records, client referrals, etc. Example: http://www.centerforethicalpractice.org/ethical-legal-resources/practice-resources/preparing-a-professional-living-will/professional-living-will-orprofessional-advance-directive/

Record Keeping

*Records are to be kept secure at all times- this usually means a locked filing cabinet in a locked office *therapists have an ethical duty to plan for the safe keeping of their records should something happen to the therapist *Full records for adults should be kept for three years (AZ Law) and then a summary for another 12 years (APA recommendation) *Full records for minors should be kept for three years past their age of majority *Clients own the info in their record and have a right to a copy of their records *The therapist owns the actual records. All this information can be subpoenaed and the client has full freedom to view those records- WRITE ONLY FACTUAL INFORMATION, info others may be able to see

Risk to Others: MR

*Ripple effect especially in closed systems- hospitals, schools, agencies, etc. *Compromises colleagues who know, places them in ethical dilemma, decreases morale, poor role models *Loss of prestige and credibility of the profession

Risk to Clients of MR

*Risk to clients *Erosion to trust** *Feelings of betrayal *Fostered dependence *Suppressed anger *Fear of separation

Therapists at Risk

*Risky therapists-- those with poor training and underdeveloped competencies. Those who have leaky boundaries or feel a need for power, adoration, or social connection *Self-disclosing therapists- need to learn to balance what is said in therapy. *Therapists that are isolated- personally and professionally- or in solo practice away from others are at higher risk for sexual MR *Theoretical orientation or specialty practice (some theoretical orientations include more therapist self-disclosure) *Each stage of career can be dangerous: -Early- inexperienced, boundaries not modeled in training -Mid- family based stressed, fear of aging (sexual) -Later- "senior pass"

Rural and small world settings

*Role conflicts almost unavoidable *25% of small town residents have some sort of mental or emotional problem (less likely to seek professional help) *Attributes of small communities? -everyone knows everyone else -gossip and rumors usually widespread -not quick to trust outsiders- talk to kin, friends, and clergy *Should never see client alone socially *Small worlds include military, religious groups, cultural groups, ethnic communities, LGBTQ *Careful of small world hazards (big pitfalls boundary crossing and confidentiality slips)

Non-sexual warning signs of MR- Therapist (p. 271)

*Seeking opportunities to spend time with client outside of therapy *Expecting client to do favors for you *Viewing client as being able to advance your position *Over-disclosing personal info and expecting client to care *Viewing client as a central person in your life *Allowing therapy to go overtime *Wishing your client was not client and instead in another relationship with you *Over-disclosing personal information and expecting client to care *Trying to influence areas of client's life not related to therapy *Allowing client to take advantage without confronting *Relying on client for your own self-worth *Giving in to client requests or perspectives to keep client in therapy *Feeling you are the only reason client improved *Resisting terminating when it would be appropriate *Jealous of client's other relationships *Allowing therapy to go ovetime

Therapist attraction to client

*Talking to client about sexual attraction is NOT recommended: *Client may not be able to handle it and become confused, uncomfortable, and unclear how to proceed with therapy *Puts therapist's issue into client's life *Client might perceive this as sexual harassment or as repulsive *Client may see this as an invitation to become sexually involved with client

Warning signs of potential sexual impropriety (Therapist)

*Thinking often about client outside therapy (sexually, not about their problem) *Recurring sexual fantasies or thoughts about client *Special care in dressing or grooming for client's appointment *Looking forward to seeing the client more than any other client *Daydreaming about seeing client socially *Eliciting non-therapeutic personal information from the client *Wanting to touch client *Believing you can make up for client's sadness, deficits, etc. *Rescue fantasies or seeing self as only person who can heal client *Sexually aroused in client's presence *Flirting with or eliciting sexual information from client

When to Breach Confidentiality

*When the client is a danger to self *When the client is a danger to others *When the client or someone acting on the client's behalf introduces the client's emotional or mental condition in litigation *when the client sues the therapist *When the therapist is appointed (that is, ordered by the court!!!) by the court to examine the client. (the court is the client, not the person) *When the client is a minor and a victim of a crime *When the client is in need of hospitalization, if they are not willing to commit themselves to care *Other instances as according to state law

Violent clients

*Younger, less experienced therapists attacked most frequently *Young, male patients most likely to attack *schizophrenic violence- delusional thinking *Personality disorders- antisocial (not responsive to treatment) and borderline (instability of mood, identity, and relationships) *If therapist responds aggresively, more likely to be harmed *Consider office environment- leave office door ajar, listen to client (don't interrupt), don't provoke, don't have heavy objects in office, no after hours, have signal for secretary/receptionist, plan for violence

Fiduciary relationship

*trust is often violated in multiple relationships *therapists who weaken boundaries foster inappropriate client dependence on them *poor role model for clients on establishing and maintaining healthy personal boundaries *continuum from a ridge to leaky- where should the line be drawn?

Dealing with Subpoenas

1) First, understand what it requires from you (testify, show up, documents, etc). 2) Turn information only if it is a court order. Court orders are signed by judge, NOT clerk or attorney. These are rare. If not a court order, must obtain client's written consent. Consent must be specific on the info disclosed, to whom, the purpose of disclosure, and client signature. Talk to your client's attorney. 3) If client is a minor or legally incapable of consent, obtain consent from parents or legal guardians. If unsure, consult with your malpractice insurer of an attorney. 4) If not court order and do not have client consent, try to contact the party requesting the info or the judge. States differ on laws, so consult an attorney. Option 1. Tell requesting party that you cannot release confidential info without consent, make sure not to indicate that you have seen client as that itself is private. Option 2. Seek help from judge and explain you wish to follow the law yet are ethically bound. Option 3. Try to quash the subpoena! Formal request to make subpoena invalid. 5) If you fear disclosure will harm client or others. May be possible to limit of info disclosed. Limit to who can see the info or how it is used. Ask court if records actually need to be disclosed. 6) If too burdensome to comply, may be able to file a motion indicating so. But do not ignore it! 7) If time frame doesn't work, try negotiation with requester. 8) NEVER IGNORE A SUBPOENA, even if not signed by a judge. Always answer, consult for legal advice, or DO SOMETHING!

Therapist-Patient Sex Syndrome: Characteristics of Syndrome (In Client)

1. Ambivalence- fear of separation but desire to escape from therapist's power. Fear of destroying therapist's personal and professional life. 2. Guilt- May feel they are to blame, didn't stop it, enjoyed it, invited it. IT IS ALWAYS THAT THERAPIST'S RESPONSIBILITY! 3. Emptiness and isolation- erodes client's self-worth. 4. Identity/Boundary/Role Confusion- reversal of roles and therapist becomes self-disclosing and his/her needs are being met. Client takes care of therapist. 5. Sexual Confusion- clients confused about their sexuality; they become threatened about their sexual activity or exhibit compulsive or self-destructive sexual encounters. 6. Impaired ability to trust- trust has been abused, life-long consequences for "trusting" relationships 7. Emotional liability- clients overwhelmed by emotions, re-experience traumatic emotions in new and appropriate sex partner 8. Suppressed rage- need to be worked through with another therapist or can affect relationships with significant other 9. Cognitive dysfunction- attention and concentration may be disrupted by flashbacks, nightmares, or intrusive thoughts 10. Increased suicidal risks- due to ambivalence, isolation, guilt, confusion, and lack of trust ***These characteristics are very similar to those in rape victims!!!

Dangerousness

1. Be familiar with the recent literature on dangerousness 2. Take a good history regarding past aggressive behaviors and obtain treatment records 3. Evaluate current intent and availability of means to carry out threat 4. Consult with colleagues 5. Document data, reasoning process, consultation, decision, and steps taken, if any. 6. Consult an attorney familiar with mental health law 7. Consider voluntary hospitalization

To Establish Privilege

1. Communications must originate in confidence that they will not be disclosed. Both client and therapist agreed that it will be confidential. 2. Confidentiality must be essential to the full and satisfactory maintenance of the relationship. Confidentiality is important for this to work. 3. The relationship must be one that in the opinion of society ought to be sedulously fostered. R/n is important to society. 4. The injury to the relationship by disclosure of the communication must be greater than the correct disposal of litigation when communication is disclosed (Client's needs to privacy outweighs the needs of society, unless court or law requires otherwise)

Subpoenas

1. Determine the nature, legality of service, jurisdiction 2. Issued by a clerk of court or judge 3. Subpoena typically requires your attendance at court or a deposition *Subpoena Duces Tecum: produce records in court of law *Initially claim the privilege on behalf of your client. *If you are a student, always notify all supervisors IMMEDIATELY *NEVER IGNORE A SUBPOENA OR A COURT ORDER *You are required to notify your client if you receive a subpoena or court order FIRST --> contact your client! If client's attorney was who sent subpoena, get permission from client to talk with attorney. In any case need a SIGNED RELEASE OF INFORMATION *If subpoenaed and client does not sign release of info, must still appear in court and simply say you must honor privileged communication *Judge then orders if privileged communication is upheld or not. *If judge says privileged comm is not upheld, it is your choice to testify or risk contempt of law (risk getting thrown in jail) --> sticky situation

Record content

1. Identifying or intake information 2. Assessment information (five areas) 3. Treatment plan 4. Case notes 5. Termination summary 6. Other data (consent forms, releases, test data, phone or other contacts, if client calls you must report that)

Assessing violence/Dangerousness

1. Patterns of escalation 2. Severity 3. Other symptoms- memory loss, absences, etc. 4. Take good history- when, how, often, target 5. Prior testing- both medical and psychological 6. Suicide attempts, property destruction, harming animals 7. Child abuse history 8. Head injury 9. Past and current medical illnessess 10. Drug and alcohol use (intoxication and withdrawal increase violance, cocaine, amphet, halluc, steroids) 11. Minor tranquilizers- xanax withdrawal 12. Organic factors- tumor, strokes, MS, alzheimers, lead poisoning

Assessment information in records

1. Psychological assessment (motivation, emotional fxn and reasoning, behavior, cognitive fxn, client psychological history and diagnosis) 2. Social and family assessment (parents, siblings, current situation, family mental health history, social fxning, abuse history, culture, religion, friends) 3. Vocational/educational assessment (work history, educational background, related tests) 4. Drug and alcohol use assessment 5. Health assessment (physical health, recent infections, head injuries, medications, life-style)

Hamman v. County of Maricopa (1987)

A mother and stepfather brought psychotic son to hospital for bizarre behavior that they found threatening, although he had not made specific threats. Given antipsychotic medication and sent home. Later he attacked stepfather. AZ Supreme Court ruled that the psychiatrist owed a duty to the parents, absent of a specific threat, to properly diagnose, treat, or control the son. There were "forseeable victims of danger" due to the parent being in constant close proximity to the "obvious zone of danger"

Values as an areas of Competence ACA Code of Ethics

A.4.b Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counselor goals. Counselors respect the diversity of clients, trainees, and research participants.

Hawaii Psychiatric Society v. Ariyoshi (1979)

An individual's decision to seek therapy is within the constitutional right to privacy and the records of medicare patients are private

Extensions of Tarasoff Duty

Bradley Center v Wessner (1982) Jabolinski v. US (1983) Hedlund v Superior Court of Orange County (1973) Ewing v Goldstein (2004)

Lapari (1980)

Disgruntled outpatient threatened to harm others. Therapist did nothing. Patient killed and injured others at nightclub. Court ruled for the "Duty to Protect" even when there is no IDENTIFIABLE VICTIM

Death of a Therapist

Ethics code indicates psychologists have a responsibility to plan for death by identifying a colleague to notify clients of the therapist;s death and to have a plan in place for the confidential transfer of client files. Literature: Impact is related more to form of client notification of death. Authors suggest changing the therapist's answering machine message immediately to cancel all future appointments, post a note on the therapist's door to cancel appointments and provide a number to call. Suggest a colleague have phone numbers of clients and instructions to notify. Instructions should also be left in regards to furthering the clients' therapy through referrals. Some suggest it may be good to offer clients their records. Not preparing for death is tied to causing clients harm (abandonment). Mixed feelings of whether all this should be discussed with client at the beginning of therapy. Always consult state laws. It's been suggested therapists should appoint a colleague as professional executor to handle all professional responsibilities. suggestions on if former clients should be notified are if individuals were clients in the past 5 years, had especially strong transference feelings, participated in several periods of therapy, or in long-term therapy. Therapist should also consider if clients should be invited to the funeral or memorial services.

Major Values Domains

Family Religion/Spirituality Abortion Suicide/Euthanasia Homosexuality

Peterson (1983)

Female plaintiff awarded monetary damages for injuries resulting from car accident with patient released five days early from inpatient hospital. Physician had perceived patient as recovered from PCP induced psychosis. NO IDENTIFIABLE VICTIM

Ethics complaints (MR)

For both psychologists and counselors, multiple relationships are one of the two primary reasons for ethical complaints and licensing board actions. Ethics charges based on role blurring are most frequently files for: sexual relationships and business relationships. Boundary violations usually arise from impulse rather than from careful, reasoned consideration of therapeutic indications

Herbert (2002)

Found that 27 states had a duty to warn imposition, 9 granted permission to warn, one state rejected duty, and the remaining states had no definite Tarasoff Law. No two states have the same approach in their duty to warn standards.

HIPAA

Health insurance portability and accountability act (1996) HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs.

Little v. All Phoenix South Community Mental Health Center (1995)

Husband feared he would hurt wife and sought help. Placed in respite care program with no Treatment. Later stabbed wife. Court ruled there was no communication of an explicit threat of serious physical harm or death to a clearly identifiable victim.

Thapar v Zezulka (1999)

In Texas, High Court ruled that mental health care practitioners do not owe a duty to third parties when a patient reveals intent to harm them. Thapar failed to warn a patient's stepfather of physical threats expressed during treatment. A month after being discharged from a mental health care facility, the patient shot and killed his stepfather.

Minors' Rights

In re Gault (1967) Gerald Gault was sentenced to 6 years to State Industrial School for a crime that would have cost $50 as an adult. Super Court later ruled that he'd been denied right to counsel, right to be notified of charges, right to confront and cross-examine witness, privilege against self-incrimination, right to appeal, and right to a transcript of proceedings. Planned Parenthood v Danforth: Gave minors right to abortion without parental consent. Minor client rights issues: Minors' ability to give informed consent, confidentiality, child-abuse reporting. Competence: children are not adults; treatment and therapeutic process is different. Therapists must be knowledgeable of developmental theories. Informed Consent: Minor can enter a contract for treatment with parental consent, involuntarily at a parent's insistence, or by order of the juvenile court. In most cases, parental consent is needed. Parental informed consent may not be required for minors above 16 y/o, emancipated minors, or when a minor is in treatment for dangerous drugs or narcotics, for sexually transmitted diseases, for pregnancy and birth control counseling, or for an examination following alleged sexual assault of a minor. Confidentiality: Parents have a legal right to all records obtained as a result of examination, evaluation, and treatment of a minor. Reporting child abuse is required by law, however, it is still one of the most common breaches of the law and ethical standards. Always report!!

Jabolinski v United States (1983)

Jabolinski killed his girlfriend, who prior to the incident had taken him to a hospital where she admitted that she was afraid of him. The hospital refused to commit him. Malpractice was found because of the failure to obtain past medical records. Failure to commit constituted negligence.

"Protective Privilege Ends Where The Public Peril Begins"

Judge Tobriner, who presided over Tarasoff v Board of Regents of the University of California, 1974

Cultural Diversity competence

MH professoinals need to be aware of their personal cultural biases and values and to understand and respect a client's diversity and worldview in all interactions

Shaw v. Glickman (1980)

Maryland court ruled for group leaders. One member sued after being shot at when found in bed with wife of another group member. Had not been warned of a "forseeable and immediate danger"

Client Identification Information

Name Address-where to contact Phone Birthdate Gender Race/ethnicity Next of kin- who to contact Education Marital status Job Legal Information Date of intake

McIntosh v. Milano (1979)

New Jersey case. Adolescent boy shot and killed female 20 year old neighbor after having affair with her. Boy stole prescription blank and pharmacist tried to call psychiatrist who tried to call the boy. Ruling that confidentiality is not absolute but yields to greater good in cases of imminent danger.

Non-professional roles

Personal- friendship, family, intimate Social Business Secondary financial

Personal vs Professional Relationships

Personal: satisfaction of mutual needs Open, evolving agendas that are not necessarily goal directed Longevity- usually last over time Professional: serve the emotional needs of clients, focus on specific therapeutic goals, terminate relationship when goals have been reached

Family Values

Role of father/husband in family Role of mother/wife in family Marriage- how is this impacted by religion, culture, race/ethnicity? Conflict and anger- how is this expressed in the family, among individuals? Is it kept to oneself, is it expressed out loud? Work- how is this defined by the individual? How does this differ across different SES, generations, age, etc? Education- how is this perceived by the individual, family, etc. What education level do they have? Role of children- How do they behave, dress, express themselves, and other expectations. What role do they have in the family? Family secrets- Every family has them, not necessarily dark. Money, family income, savings, etc. Mental illness, learning disabilities, etc. Sex- what is appropriate sexual behavior? What was learned from family? What impact did each of these have on the client and their life experience? How does differ across ages and across generations. How do each of these values interact with other values? (SES, Ethnicity/Race, Religion, etc.)

Types of MR

Service and bartering Gifts- giving and receiving Client referrals Small world hazards Favors Business partnerships Financial advice Employees Therapy outside of professional setting

Jaffee V. Redmond (1996)***VERY IMPORTANT!

Supreme Court recognized that the client of a licensed social worker had privileged communication. First case court where the privilege communication of a master's holding licensed professional was upheld.

Griswald v. Adams (Connecticut) (1965)

Supreme Court struck down a Connecticut statute prohibiting use of contraceptives by married couples

Roe v. Wade (1973)

Supreme court held that criminal abortion laws, which proscribed abortion except for the purpose of saving the mother's life, were unconstitutional. (Supreme Court decided on women's right to privacy, which included abortion)

Eisenstadt v Baird (1972)

Supreme court reversed defendant's conviction for distributing contraceptives to unmarried people

John Geddes Lawrence & Tyron Garner v Texas (2003)

Supreme court ruled that the "state is not omnipresent in the home." "Liberty presumes an autonomy of self that includes freedom of thought, belief, expression, and certain intimate conduct."

Bowers v. Hardwick (1985)

Supreme court upheld Georgia antisodomy statute and rejected the assertion that the right to privacy includes the right of homosexuals to have sodomy. (ridiculous!!!!)

The Tarasoff Case (VERY IMPORTANT!!!!!)

Tarasoff I, established the duty to warn, was the result of the initial civil suit filed by the Tarasoff family in 1974. (DUTY TO WARN: therapist NEEDS to contact the potential victim and warn them of potential harm) In 1976, Tarasoff II, which extended the duty to warn to a broader duty: that of protecting potential victims (DUTY TO PROTECT: therapist MUST do everything they can to prevent harm, by hospitalization, contacting the police, etc.) IDENTIFIABLE VICTIM, INTENT

Types of Professional Roles

Teacher, therapist, supervisor, consultant, researcher, advisor

Ewing v. Goldstein (2004) & Ewing v. Northridge Hospital (2004)

This case represents the largest expansion of Tarasoff. Geno received therapy for distress due to his former girlfriend dating a new man, Keith. Geno asked to borrow his dad's gun and told his dad he planned to kill Keith. The Dad told Geno's therapist and had him hospitalized. After his release the next day, he shot and killed Keith and then himself. Extended to include statements disclosed to the therapist by a family member or other third-party indicating a threat as duty to warn and duty to protect.

Major Boundary issues (Be careful of leaky boundaries!)

Time (respect the time appointed, and no other) Place (In a professional setting, office, hospital, etc. and never elsewhere) Dress (Professional and appropriate) Touch (what physical contact is and is not allowed) Therapist self-disclosure (what can you say about you, what information can or should the client know) For exam: Name a major boundary issues and GIVE CLIENT EXAMPLE!

Peck (1985)

Vermont court ruled that school counselor should have warned parents about son who burned down the family barn

Bradley Center v. Wessner (1982)

Wessner was involuntarily committed after finding out about his wife's affair. He reported he had a gun and planned on killing his wife and her lover. When on a weekend pass, he killed both as he described. (Duty to warn, duty to protect)

Need to refer:

When a therapist cannot bring their sexual attraction and feelings under control or sense that these feelings are having a negative impact on therapy and when consultation was sought but was ineffective, a sensitive termination and referral can protect all parties from complications, confusion, and harm (p 308)

Multiple relationships

When professionals assume two or more roles simultaneously or sequentially within a person seeking help. This might include two pro roles or a combination of professional and non-professional roles. APA (3.05a) defines multiple relationships as occurring when a therapist is already in a professional role with a person (client, student, consultee, supervisee, etc.) and 1. Is also in another role with the same person 2. Is also in a relationship with someone closely associated with this person 3. Makes a promise to enter into a relationship in the future with the person or someone closely related to this person

Hedlund v. Superior Court of Orange County (1973)

While receiving therapy from Hedlund, Steve Wilson reported he wanted to hurt his wife. Steven then ran his wife and her son off the road and then shot her, causing her to lose her leg. She sued for failure to warn.