Counseling Ethics Part 2

Group Supervision

Between a member of the counseling profession and more than two counseling students/interns

Triadic Supervision

Between a supervisor and two counseling students/interns

Benefits of group supervision:

Enhancement of knowledge and skills Ability to practice techniques in a safe and supportive environment Integration of theory and practice Richer understanding of patterns of group dynamics Opportunities to test one's assumptions Personal development through connection with others Opportunities for self-disclosure, for giving and receiving feedback

Fee Splitting aka 'kickback'

Ex: You are paying me for the referral's I give.

NONEROTIC PHYSICAL CONTACT WITH CLIENTS

Examples: handshake, touch on the hand, arm, shoulder, a hug, brief physical contact

Bartering

Exchanging counseling services in lieu of paying a fee; instead accepting goods, services, or other non-monetary remuneration from clients

Ethics of Forensic Activities "Forensic mental health work"

-refers to professional activities that involve courts of law. Ex: conducting child custody evaluations, assessing a person's competence to stand trial, acting as an expert witness in a legal case. Central ethical issues parallel other forms of practice: competence, consent, confidentiality, conflict of interest, boundaries, and power. Texas has created separate rule section to address this area of practice: Subchapter N: Parenting Coordination and Facilitation and Child Custody and Adoption Evaluation

__________ relationships are common in graduate school.

Mentoring

Can professional counselors deny counseling services to a homosexual person (or an individual belonging to any other protected class of clients) on the basis of the counselor's values?

NO

Does the legal concept of privileged communication generally apply in a group setting?

NO

What are some examples of dual relationships?

Assuming more than one professional role or blending a professional and nonprofessional relationship Providing counseling to a relative or a friend's relative Socializing with clients Becoming emotionally or sexually involved with a current client or former client Combining the roles of supervisor and counselor Having a business relationship with a client Borrowing money from or lending money to a client Providing a client with a place to stay

Suggestions for at-risk clinicians:

Avoid the isolation of private practice Closely monitor boundaries with clients Obtain ongoing professional supervision Seek their own therapy to address any relationship-related issues within their own life.

CHARACTERISTICS OF COUNSELORS WHO BECOME SEXUALLY INVOLVED WITH CLIENTS

Fragile self-esteem Difficulty establishing intimacy in their personal lives Professional isolation A need to rescue clients A need for reassurance about one's attractiveness Substance abuse issues

Codes of ethics caution professionals against any involvement with clients that:

Might impair judgment and objectivity Affect ability to render effective services Result in harm or exploitation to clients

MOST COMMON REACTIONS OF CLINICIANS TO SEXUAL FEELINGS IN THERAPY

Surprise, startle, shock Guilt Anxiety about unresolved personal problems Fear of losing control Fear of being criticized

CLUES OR WARNING SIGNS SEXUAL MISCONDUCT

Telling sexual jokes or stories. Sending obscene images/messages. Unwanted physical contact. Excessive out-of-session communication. Inviting to lunch, dinner, or other activities. Changing office's business practices (late appointments alone, away from the office). Confiding in client (about love life, work problems, loneliness, marital problems). Relying on client for personal/emotional support. Providing/using alcohol or drugs during sessions.

Consequences of sexual misconduct with client

being convicted of a felony having license revoked or suspended being expelled from professional organizations losing insurance coverage losing job/career

Harmful effects of sexual boundary violations include...

distrust of the opposite sex distrust for therapists and the therapeutic process, stating will never seek treatment in future guilt depression anger feeling of rejection suicidal ideation low self-esteem

Mental Health Expert Witness

"someone who wasn't there when it happened but who, for a fee, will gladly imagine what it must have been like"

Guidelines for faculty - maintaining ethical relationships with students

(1) Faculty recognize potential for harm in dual relationships with students; aware they hold a position of power and authority over students. (2) A framework is necessary for evaluating appropriate and inappropriate conduct. (3) Emphasis placed on establishing and maintaining a climate for ethical relationships between faculty and students.

Post-termination contact with Type B clients is permitted only if the following conditions are met...

(1) The initiation for the contact does not come from the therapist; (2) at least two years have elapsed since therapy; (3) no social contact has occurred in that two-year interval (4) therapy was completely terminated, and no recommendation for follow-up treatment was given.

The Drug Abuse and Treatment Act

(1976) -Guarantees the privacy of all records related to evaluation of treatment for substance abuse for any entity receiving federal funding. -This law establishes strict guidelines for the release of such records and stipulates that minors receiving such treatment have privacy rights and must consent to release of their records, even to their parents.

The Grassley Amendment

(1994) -Mandates that schools have parental consent for surveys, research, evaluations of info related to personal or family life of studnets.

Goal

- promote, restore, or maintain the independent functioning of clients in the least-restrictive community environment.

Reasons to self-disclose to a client?

- promoting client self-disclosure - fostering the therapeutic relationship/alliance - encouraging clients' autonomy and facilitating client self-exploration - normalizing and promoting feelings of universality - attempting to equalize power - assisting clients in identifying and labeling their emotions - showing similarities - building client self-esteem

Ethics of Coaching

-Coaching as a practice activity for mental health professionals emerged fairly recently & grown dramatically. Central ethical issues in coaching parallel those in counseling - confidentiality, consent, conflict of interest, and boundaries. No state licenses individuals for the practice of coaching or has requirements for coaching practice in their jurisdictions

Ethics in Addiction Counseling

-Competence is crucial; abuse of substances is one of the most common problems clients experience Occurs in conjunction with other mental health, social, and employment problems. For reluctant or mandated clients, important to explore degree to which there is some voluntary component to their presence in treatment. Counselors use their power wisely and do not manipulate or coerce clients, but educate them about the consequences of their substance use.

ACA Ethics Committee has how many members? Serves how many terms? Has how many graduate students?

-Educates members about ethical standards, deals with ethics questions and complaints -9 members (professional counselors) serving 3 year terms -one graduate student serving a 1 year term

Simultaneous purposes of supervision

-Enhancing the professional functioning of the more junior person(s) -Monitoring the quality of professional services offered to the clients seen -Serving as a gatekeeper of those who are to enter the particular profession.

Methods of supervision

-Self-report: one of the most widely used methods, but it way be least useful. -Process notes -Audiotapes -Videotapes -Live supervision

Working in a system can put an added strain on the counselor due to several factors:

-The amount of paperwork required to justify continued funding High caseloads A multitude of policy directives

Six major responsibilities to clients:

1) Fees Charged to services 2)Interruptions/Terminations of services 3) Records of services 4) Advertising services/Soliciting clients 5) Public Statements and Other Interactions with the Media 6) Involuntary Commitment

Some causes to therapist sexual misconduct

1) One's ability to handle sexual feelings toward a client without supervision, coupled with a lack of training in the issue. 2) Problems in professional competence stemming from distress, burnout, and difficulties in the clinician's personal life that spill over into therapeutic relationships 3) Their character - individual's fundamental lack of concern for the welfare of the client

Accepting a gift is likely (but not always) to be ethical if:

1) Promotes, rather than endangers, client welfare 2) Does not compromise therapist's objectivity 3) Token consistent with cultural norms and is of small monetary value 4) Is a rare event

Three legal consideration in the supervisory relationship

1) informed consent 2) confidentiality and its limits 3) liability

Six central ethical mandates for community-based practitioners

1) recruit clients with fair, complete, and honest descriptions of their capabilities and credentials 2) Fees charged are fair, clear and sensitive to financial status 3) Have alternative care in place if service must be interrupted 4) Up to date records of service 5) if outside sources mandate therapy, the professional gives primary allegiance to the client, with due respect for the rights of the third parties and informed consent for all involved. 6) if clients need to be hospitalized against their wishes, the procedures used should be respectful to clients and minimally restrict their freedom.

Four Goals of supervision

1) to promote supervisee growth and development 2) to protect the welfare of the client 3) to monitor supervisee performance and to serve as a gatekeeper for the profession 4) to empower the supervisee to self-supervise and carry out these goals as an independent professional

Supervision standards have been incorporated in what?

ACA Code of Ethics in 2014

The American Disabilities Act

1990 -Gives Parents access to student files -That law stipulates that if parents are disabled, the school must provide information in the records in a form they can understand

No Child Left Behind Act

2001 (NCLB) was a U.S. Act of Congress which reauthorized the Elementary and Secondary Education Act; it included Title I provisions applying to disadvantaged students.

How many supervisor training hours in required in Texas?

40 hrs

How many years are needed in Texas to supervise post-grad interns?

5 years

Boundary crossing (extension)

A change in role and departure from commonly accepted practices that could potentially benefit clients.

Outpatient Commitment

A person is not hospitalized, but is kept under supervision in the community

Multiple relationships

A practitioner is in a professional role with a person, in addition to another role with that same individual, or with another person who is close to that individual. (counselor-client nonprofessional/ nontherapeutic relationship)

Boundary violation (break)

A serious breach that is a departure from accepted practice and results in harm to clients through exploitation of the client at some level.

Individual Supervision

A tutorial and mentoring relationship between a member of the counseling profession and a counseling student/intern

-Best Practices in Supervision document published by ...

ACES (2011)

A THREE STEP MODEL OF RECOVERY Step 1

Acknowledging the violation -To fully acknowledge the ethical lapse and understand its nature and scope without catastrophizing about it. -careful reflection and tolerance for the emotional discomfort

A THREE STEP MODEL OF RECOVERY Step 2

Addressing and Responding to the Damage -Assessing harm to the client is the top priority, followed by damage to colleagues, others in the community, and to the reputation of the profession. -Have consultation -Try to remedy the harm and make amends

ASGW

Association for Specialists in Group Work

ASCA

American School Counselor Association

Supervision

An intervention provided by a more senior member of a profession to a more junior member(s) of that same profession.

IRBs (institutional review boards)

Approve and oversee the conduct of any research that involves risk of harming human subjects. -have the power to approve, reject, or mandate changes in research proposal

Supervisors are responsible for ?

Competence/fitness of those they supervise

One of the most difficult issues facing school counselors and school psychologists?

Determining whether a disclosure from a student should be kept confidential of disclosed to parents or school authorities.

Association of Counseling Education and Supervision (ACES)

Developed "Ethical Guidelines for Counseling Supervisors" (2000)

FERPA

Family educational rights and privacy act -(1974) is a federal law which restricts the disclosure of academic records (aka Buckley Amendment)

Involuntary Commitment

If clients need to be hospitalized against their wishes, the procedures used should be respectful to clients and minimally restrict client freedom.

Interruption/Termination of services

If service must be interrupted, mental health professionals ought to have in place mechanisms for alternate care so that clients' therapeutic progress will be minimally disrupted by the interruption. Specific and multiple options for referrals must be provided to the client

681.92 (e)

LPC CODE

What is the correct term, LPC-I or LPC-Intern?

LPC-Intern

The ethical violations in a community are _____ complex and ______ to resolve than violations pertaining to individual counseling.

MORE DIFFICULT

Multicultural Supervision

Includes issues of race, ethnicity, socioeconomic status, sexual orientation, religion, gender, disability, and age.

Ethics in College Counseling

Increasing numbers of students with chronic and severe emotional concerns Increasing liability for student suicides and acts of violence. Serve on threat assessment team; collaborate with administrators to develop policies that assess threat and protect student privacy. Keep up to date with laws in their state or jurisdiction regarding privilege/duty to protect. Limits of confidentiality that apply to their clients/students must always be explained fully.

Public Statements and Other Interactions with the Media

Interact ethically and responsibly with media, giving public testimony before legislature, or commenting about social problems. Interactions should educate the public and bring credit to the profession.

Screening

Interviewing and evaluating potential members to select suitable group members.

Why would some marriage and family therapists refuse to see a member of a family separately?

One view is that therapists should not divulge in a family session any information given to them by individuals in private sessions. Others reserve the right to bring up certain issues in a joint session. Some have a policy of refusing to keep information secret that was shared individually. Some favor informing their clients that any information given to them during private sessions will be divulged as they see fit in accordance with the greatest benefit for the couple or the family

Who can supervise LPC in Texas?

Only LPC-S -Board Certified

How many supervisors is an LPC intern allowed at a time?

Only two LPC board approved supervisors on file at any given time.

Vicarious Liability

Pertains to the responsibility that supervisors have because of the actions of their supervisees.

Challenges in Supervisory Relationship

Poor Match between supervisor and supervisee -The critical or difficult supervisor -The absent supervisor -The inadequate supervisor -Frequent change in supervisors -Dual relationships -Overworked or overwhelmed supervisor -The unethical supervisor

Responding to an ethics complaint if one is filed against you

Professionals need to: Cooperate with formal requests Get legal and emotional support Avoid personal contact with the person filing the complaint Admit wrongdoing if it occurred, explain the context, and demonstrate remorse as well as a plan for change

Fitness implies ____________, including the following variables:

Psychological health -self-awareness, self-acceptance , self-knowledge, self-confidence, courage, resilience, purpose in life, balance, moderation, and emotional stability

Opportunities and challenges in supervisory relationships

Recognizing a problem may exist is the critical first step

Advertising services/Soliciting clients

Recruitment of clients with fair, complete, and honest descriptions of capabilities and credentials; avoid direct solicitation of potential clients.

Fee Splitting aka Kickback

The practice of paying a fee to someone who provides referrals or receiving a fee from a professional to whom one sends referrals.

Forensic Mental Health Work

Those professional activities of a psychologist, counselor, or social worker that involve courts of law

Fitness

suitability for being a professional counselor.

Systems theory

Views psychological problems as arising from within the individual's present environment and the intergenerational family system.

Multiple-role relationship in supervision

When a supervisor has concurrent or consecutive professional or nonprofessional relationships with supervisee in addition to the supervisor-supervisee relationship.

Involuntary or Civil Commitment

When the placement happens without the person's consent

Do supervisors keep records pertaining to their work with trainees/supervisees?

Yes

Does Texas consider sexual misconduct a criminal offense?

Yes

Does the supervisor have a relationship with the supervisee's clients?

Yes

Are supervisors ethically and legally responsible for the actions of their trainess/supervisees?

Yes. 681.93 (b)

Direct Liability

can be incurred if supervisors are derelict in the supervision of their supervisees, if they give supervisees inappropriate advice about treatment, of if they give tasks to supervisees that exceed their level of competence.

A counselor's __________ and ______ have more influence on boundary crossings than training and theoretical orientation.

character and values

Two levels of competencies and related training to group work

core knowledge and skill competencies

The burden of demonstrating that there has been no _________ clearly rests with the counselor.

exploitation -Amount of time that has passed since termination Nature and duration of counseling Circumstance surrounding termination of therapeutic relationship Client's personal history Client's competence and mental status Forseeable likelihood of harm to client or others Any statements/actions by counselor suggesting plan to initiate sexual relationship after termination

Fees charged for services ought to be...

fair, clearly communicated, and sensitive to financial status of the client. Have a right to a fair income, but not allowed to place your own financial gain ahead of the welfare of clients.

You should study an agency's _________________ before you accept a position

philosophy

Case management involves...

planning and coordinating approaches to treatment.

The most commonly reported reasons for seeking couples therapy were

problematic communication and lack of emotional affection.

Records of services should be...

up-to-date, accurate, and confidential so that competent service can be provided and privacy can be protected. Maintained for follow-up care to be provided, and disposed of in ways that guarantee client privacy and follow the law.

When do school counselors most likely break confidentiality?

•Impending suicide with a firearm (97.6%) or information about possible suicide pact (88%) •Retaliation for victimization (94.2%) •Use of crack cocaine (83.7%) •Sexual intercourse with multiple partners when HIV positive (80.7%) •Imminent armed robbery plan (79.5%) •Indications of depression (76.9%) •Abortion (69.1%) •Marijuana use (68.7%

Group Co-Leadership Advantages

◦ The leaders can complement and balance each other. ◦ The leaders learn by discussing what goes on in the group and by observing each other's style. ◦ Together, they can evaluate what has gone on in the group and plan for future sessions. ◦ While one leader is working with a particular member, the other can be paying attention to others in the group.

Ways a group leader might use techniques unethically:

◦ Using techniques with which they are unfamiliar ◦ Using techniques to enhance their power ◦ Using techniques whose sole purpose is to create intensity, because of the leader's need for intensity ◦ Using techniques to pressure members, even when they have expressed a desire not to participate in an exercise

The role of the family therapist is...

◦To help family members see more clearly what they are doing, ◦To help them make an honest evaluation of how well their present patterns are working for them, and ◦To help and encourage them to make necessary changes.

At both the screening session and at the initial group meeting:

◦explore the members' expectations ◦ clarify goals and objectives ◦discuss procedural details ◦explore the possible risks and values of group participation ◦discuss guidelines for getting the most from a group experience