Maintaining Ethical, Legal, and Professional Standards

Which of the following presents the greatest risk to obtaining and maintaining confidentiality?

A large family in therapy Notice that this question did not define its terms in much detail. Do not read more into a question than what is given. The more people you have in a therapy session, the greater the chance that information will be spread around. A similar example of this is group therapy. In this case, the therapist promises to maintain the confidence of the group and may have members sign a statement in which they promise to maintain confidentiality outside of the group. The larger the group, however (be it a therapy group or a large family in therapy), the greater the risk that someone will share confidential information with others outside the treatment setting.

The therapist routinely searches social media for information about her clients. What does this represent?

A situation where the therapists objectivity may be compromised Objectivity might be compromised if the mental health provider learns information about the client as a result of a search.

What is the difference between a subpoena issued by a judge, versus one issued by an attorney?

A subpoena generated by a court is considered a court order. In contrast to subpoenas generated by attorneys, a subpoena generated by a court is considered a court order and is generally issued only after a hearing before a judge. Such a court order is likely to compel a disclosure, unless the order is appealed to a higher court.

The therapist realizes that she made an error in her client record, writing that the client had been arrested for petty theft when in fact, the client had not been. How should the therapist deal with this error?

Add an addendum to the client record correcting the entry The correct action to take is to add an addendum to the client record correcting the entry.

Your client begins to come to sessions dressed more stylishly than usual and begins asking you about your personal life. How should this be addressed in therapy?

Discuss appropriate boundaries with the client The client's behaviors suggest the possibility of an issue within the therapeutic relationship, or at the very least, a loss of therapeutic boundaries. Discussing therapeutic boundaries with the client is the proper response to this type of behavior.

The therapist discovers that his new client is also the librarian at the library he uses. What should the therapist do?

Discuss boundaries Unless the client and therapist are friends, this does not necessarily represent a discouraged dual relationship. Therefore, discussing boundaries as part of the therapeutic contract is appropriate.

Which statement is NOT true regarding subpoenas?

If a subpoena arrives from a clients attorney without a signed clients release form it is fine to release the records. If a subpoena arrives from a clients attorney without assigned clients release form, check with the client (not with the attorney) before releasing the documents. Technically, a request from a clients attorney is legally the same as a request from the client himself or herself, however licensing laws in all states require written authorization from the client before disclosing confidential records (absent a court order).

John is seeing a new client who was referred by the local crisis clinic. They explore the client's issues and decide to proceed with therapy. John explains to the client his policies, limits to confidentiality and the fact that a good outcome is not guaranteed. He does not, however, put this in writing for the client. What should John have done?

John's actions were appropriate No legal or ethical standard requires that informed consent be obtained in writing.

What is the most common ethical issue faced by therapists?

Maintaining boundaries The most common ethical issue faced by mental health professionals is maintaining boundaries. At times it can be difficult to avoid developing a personal relationship with a client. Sometimes clients may blur or attempt to blur the lines because of how the therapist-client relationship develops.

Several sessions into couple's therapy, the husband calls the therapist in between sessions and says that he is having an affair. What is the proper course of action for the therapist to take?

Schedule an appointment to talk to the man about whether couples therapy can continue in light of this information It would be unethical to continue couples therapy where there is a secret of this magnitude. The best course of action would be to have a session with the man and encourage him to tell the secret, with the help of the therapist. If he is not willing to reveal the secret, then couples therapy should be discontinued.

Brenda is a mother of three who is in therapy due to substance abuse issues. One day, she tells her therapist that she whipped her oldest daughter with an electrical cord because the child talked back to her and refused to do what she told her to do. She tells the therapist that, "If you tell anyone, I wont come back to therapy." What should the therapist do?

Tell Brenda that the therapist is a mandated reporter and therefore must make a report, and invite Brenda to participate in the call so that she can tell her side of the story. There are situations (dangerousness) where one would not want to tell the client that you are making a report, but this is not one of them. Involving the client in making the call (if possible) helps demystify the process, and helps to frame the report as an opportunity for the client to get additional help in changing their behavior.

Mike and Linda saw their therapist for three years before deciding to divorce. A year after the therapy concluded, the therapist gets a request from a psychiatrist asking for records for Linda, who has had a psychotic break. Linda has signed a written Release of Information for information from the file that pertains only to her. The therapist attempts to locate Mike to get his permission to release information, since the therapy was conjoint, but cannot contact him. What should the therapist do in such a situation?

Tell the psychiatrist that he cannot release the record Since the therapy involved the couple, the therapist needs to have Mike's permission as well as Linda's, to release the records.

A client contacts the therapist from another state and asks to be seen using the therapist's telehealth site. The therapist specializes in working with people who are in cults, which is why the client is not seeking someone locally. She is in a group and is beginning to see that it is not a healthy situation, and needs help figuring out how to extract herself and her two children. What is the most important thing the therapist must make sure of?

That it is legal to provide services via telehealth in the client's jurisdiction.' The most important thing the therapist needs to do is make sure that it is legal to provide services to the client in the state where the client resides.

A therapist returns a call and the potential client would like to schedule an appointment. The therapist informs the client that the fee for the intake appointment is $200. What must the therapist keep in mind regarding the fee?

The fee for on-going therapy must be set after the intake appointment and before the next appointment. The client needs to know what the fee for therapy is as part of the informed consent process. This fee may be different from the fee for an intake appointment.

The therapist is working with a woman who has problems with hoarding and also has an eating disorder. One day, the client tells the therapist that she hasn't eaten in five days, and is feeling very weak. If the therapist were to advise the client to start eating simple foods to start with, moving up to more complex foods, what would be true in this case?

The therapist is acting outside her scope of practice in advising the client on what to eat. The therapist is acting outside her scope of practice in advising the client on what to eat. The proper action would be to help the client get an immediate appointment with a medical professional, who can assess and prescribe the proper treatment for the clients situation.

A previously suicidal client calls her therapist and states that she has "finally had enough" and is going to "put an end to things." The therapist calls the client's home and the client's husband says he doesn't know where his wife is. There is no release of information allowing the therapist to talk to the husband. What does the law permit in this situation?

The therapist may speak to the husband about her concerns about his wife's welfare. Health care providers are allowed to speak to others who are involved in or important to client care, in an emergency or other situation even if there is no release authorization.

Which of the following situations represents the worst example of ethical conduct?

Writing a letter of recommendation for a client All of the situations represent a potential dual relationship issue, but the other choices are a matter of judgement, whereas writing a letter of recommendation for a client crosses a clear boundary.

A recently-divorced 32-year-old woman makes an appointment with you at the recommendation of her physician who has diagnosed her recurrent headaches as tension headaches. The woman tells you that a friend of hers was trained in self-hypnosis for a similar problem and that she also wants training in self-hypnosis. You took a course in graduate school on hypnosis that covered self-hypnosis but have not used hypnosis in your clinical practice. You should __________________________.

admit your lack of expertise in the use of self-hypnosis and refer the woman to another therapist To identify the correct answer to this question, you needed to consider scope of competence issues. You would be acting unethically if you provided a treatment you were not competent to use. According to the question, you've only had one class on hypnosis. This is unlikely to be enough education, training, or experience to make you competent. It would, therefore, be in this client's best interest to refer her to another therapist.

The therapist is seeing a family that consists of a single mother, two toddlers and a baby. The mother was mandated to attend therapy because there were some issues of neglect that were reported to protective services. The mother has no transportation, and very little social support, so often misses appointments. The therapist decides to see the mother for home-visits instead of requiring her to come into the office for sessions. This action is:

appropriate There is no rule against doing therapy in the client's home. Sometimes it is the only way to provide services, and in this case, since the issue is parenting, is actually very appropriate. The therapist can work with the mother in vivo (in the home environment) making it more relevant to the problem as compared to working in the office.

Ethical standards would suggest that when a marriage and family therapist cannot continue seeing a particular client, the therapist should __________________.

consider the client's needs and make the most reasonable arrangements for the continuation of treatment with an appropriate professional Only one of these answers is complete, so it was important to read every answer before choosing one. One clue to the best answer was in the words "consider the client's needs." This is the best answer because it properly identifies a marriage and family therapist's ethical obligation to arrange for alternative services in this circumstance. The AAMFT Code of Ethics states that marriage and family therapists do not abandon or neglect patients in treatment without making reasonable arrangements for the continuation of such treatment (Standard 1.11). Referral is directly mentioned in this answer, and doing the proper termination work is implied by the words "consider the client's needs."

One day the therapist receives a call from Mary, who asks to be seen due to "relationship issues." In the first session Mary complains about how she and her husband "never talk" anymore, and rarely have sex or even go on vacations together. The therapist tells Mary that it sounds like the problem is in the relationship and recommends couples therapy if Mary and her husband agree that is what they want. This action on the part of the therapist is:

ethical The therapists job is to assess the problem and make the best recommendation he can for treatment. In this case, the assessment reveals that the problem is in the relationship, therefore, couples counseling, if the couple is amenable, is the best recommendation. If Mary does not want couples counseling (of if her husband chooses not to come in) then individual counseling is appropriate.

A divorced, single mother has to terminate therapy with you because her insurance has run out. You should _____________________.

give her a few referrals to low-fee alternatives in her area The question asks what you "should" do, which implies that you should consider clinical and ethical issues. Of course, it would be appropriate to continue treating the woman for no fee or a low fee, but that choice is not offered. The Ethics Code states that, if a therapist is unable or unwilling, for appropriate reasons, to provide professional help, that therapist should assist the client in obtaining other therapeutic services for continuation of his/her treatment. Since this client can't afford therapy, the referrals may need to be to low-fee agencies or support groups.

Susan and Howard have recently filed for divorce. Susan comes to see you for individual therapy. The couple has agreed to split the possessions they purchased jointly during the six years they were married. Their only dispute is over the custody of their 4-year-old son, Sam, who is currently living with Susan. Howard has charged that Susan is an unfit mother and the court has asked you for your evaluation. During your assessment of Susan, you find that she is somewhat withdrawn and a little depressed. The court asks you for your recommendation in this case. You should _________________.

not present a recommendation until you evaluate not only Susan but also Howard and Sam Although it might have seemed difficult to find the right answer, the correct answer is based on a specific criterion. Marriage and family therapists and others who are asked to make custody recommendations may not recommend placement with one or the other parent unless they have had an opportunity to evaluate all parties involved in the dispute. If you can only evaluate one person, you can comment on that person, but cannot make specific recommendations regarding placement. As a marriage and family therapist, you should be aware that how Sam reacts to Susan, how Howard is with Sam, how Susan is when she is with Sam, etc., would all be relevant and important data.

An MFT should never ______________________.

suggest a particular medication to a client You needed to notice the word "never" in the question, which is an absolute word. The only action listed that an MFT can never do is advise a client regarding medication. Only trained medical doctors can prescribe or provide advice about medication.

Mary Harding has just gotten her marriage and family therapist license and wants to attract new clients. She decides to publish a brochure about her services, which she will distribute to community organizations. She asks clients whom she treated when she was an intern to write brief recommendations of her work, describing how they were helped. According to AAMFT ethical standards ______________________.

this is inappropriate advertising because such recommendations might mislead the public into believing they were guaranteed similar successful results Notice that you had to choose the answer that is true "according to ethical principles." The AAMFT Code of Ethics provides guidelines on advertising. According to AAMFT ethical principles, advertising must not be deceptive or mislead the public, and should enable laypersons to choose services on an informed basis. A statement is considered to be deceptive if it is intended or is likely to create an unjustified expectation, as could occur when client testimonials are used (i.e., consumers may expect similar results in treatment).