Ethics

Counselor Competence

"counselors must practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national credentials, and appropriate professional experience", know ethics and law, practice only services for which they are trained, resolve personal issues

What are the 3 basic elements of the legal aspects of informed consent?

-Capacity -Comprehension of Information -Voluntariness

What are the 4 requirements of Informed Consent?

-Client be Competent -Have knowledge of what will occur -Know the risks involved -Give consent to treatment

What are the 7 types of information within Progress Notes?

-Diagnosis -Functional Status -Symptoms -Treatment Plan -Consequences -Alternative Treatments -Client Progress

What are the 2 Rights of Informed Consent?

-Right of client to be informed about their therapy -Right of client to make autonomous decisions pertaining to it

Confidentiality exceptions and information must be reported by practitioners when

1. CLIENT CONSENT 2. Abuse/neglect of a child/elderly/disabled person is report 3. Duty to warn 4. Court ordered 5. Suits Affecting Parent Child Relationships (SAPCR) 6. TOCATA 7. Counseling Supervision

Research in Counseling

4 ethical issues: provide informed consent, avoid coercion and deception, protect confidentiality and privacy, report results - also to clients if they ask

The new ACA ethical guidelines stipulate that a counselor can refrain from making a diagnosis if the counselor believes the diagnosis could harm the client or others.

A counselor could refrain from making an Axis I or an Axis II diagnosis if it is in the best interest of the client & A decision to refrain from making a diagnosis is ideally made in collaboration with the client, although the counselor has the final say.

When a counselor has a personal loss or a crisis, what should they do?

A counselor may have to seek professional help or at least consult a colleague.

How does Informed Consent relate to Minors?

A parent or guardian is typically responsible for giving Consent A minor typically gives informed assent

When will a therapist need to gain a Lawyer when it comes to Malpractice?

As soon as possible

What is the Slippery Slope Phenomenon?

Certain actions will inevitably lead to a progressive deterioration of ethical behavior

What is Capacity in relation to the legal aspects of Informed Consent?

Client has the ability to make rational decisions

How does Receiving Gifts relate to Culture?

Eastern cultures give gifts as a sign of respect, refusal could damage the future of the relationship

A counselor has an answering machine in her office. Which statement most accurately depicts the ethical guidelines related to this situation.

Ethical guidelines allow answering machines, but experts insist that unauthorized staff should not be allowed to listen or retrieve such messages.

(T or F) Counselors must develop counseling plans that best suit clients needs.

False. Counselors must develop realistic counseling plans in conjunction with clients

What is Risk Management?

Practice of focusing on Identification, evaluation, and treatment of problems that may injure clients, lead to a filing of ethics complaint, or result in malpractice

The ACA code of ethics in relation to child & adolescent counseling

School counselors do not need to get parental consent to counsel children in schools.

What is the slippery slope phenomenon?

This is when the counselors' relationship boundaries are poorly defined. Also, when they attempt to blend roles that do not mix, multiple relationships can bring harm to clients.

(T or F) Counselors must establish appropriate fees.

True. Counselors must establish ________ fees.

When should a client be referred to another counselor in relation to Sexual Attraction?

When the therapist is preoccupied with the attraction

A client wants to read her record. Pick the statement which is not accurate.

You should allow her to read it, however, you should go back and change things you don't want her to see; for example, the fact that you said she was schizophrenic.

Internet - Attempt to make their web sites as accessible as possible to clients with disabilities.

__

You are a supervisor at a sexual abuse treatment agency. Sally is one of your counselors and you give her a performance rating on a yearly basis. Sally has been having panic attacks on a daily basis at home for almost a month and her physician feels that counseling rather than medicine is indicated. Now—for the first time—she has a terrible panic attack at work. If you don't see her the nearest counselor is 150 miles away. You should

attempt to counsel her.

You are a licensed professional counselor in one state but will soon relocate to another state. The new state informs you that they will grant you reciprocity or so-called endorsement. You will thus

be permitted to practice in the new state based on your current credentials without taking another exam.

An 11-year-old child comes to your office with a black eye and tells you she can't remember how she received it. You have reason to suspect abuse. You should

call the child abuse/neglect hotline.

Ethical dilemmas rarely have clear-cut answers. Thus when a complex ethical situation manifests itself, it is best to

consult with colleagues as well as ethical codes inasmuch as legal standards are very often based on the methods of fellow professionals in analogous situations.

During a counseling session a 42-year-old male client threatens suicide. You should

contact his wife and advise her of possible suicide precautions.

Your client was seeing Dr. Doyle for counseling for three years. The client has now stopped seeing Dr. Doyle and has an appointment to see you. You should

counsel the client.

Sharing Information - Confidentiality

counselor duty; a counselor's ethical duty to fulfill a promise to client that revealed info will not be shared

Nondiscrimination

counselors do not condone or engage in discrimination based on age, culture, disability, ethnicity, race, religion / spirituality, gender, gender identity, sexual orientation, marital status / partnership, language preference, socioeconomic status, or any basis proscribe by law

One possible negative aspect of counselor licensure is that

counselors may not be as creative during their graduate work and simply take courses aimed at fulfilling the requirements to take the licensure exam.

A 72-year-old woman you are counseling in a family reminds you of your mother and this is bringing up unresolved childhood issues for you as the counselor. This is an example of

countertransference.

Nonmaleficence

do no harm

Beneficence

doing good; benefiting other, and preventing harm

Fidelity

faithfulness, keeping promises, honoring commitments

Autonomy

freedom of choice and self determination, respecting a person's right to make choices for him/herself

Breach of confidentiality

however law overrides privacy rights when it is necessary to protect public health, safety, and welfare

(COE) Section 5 - Evaluation, assessment, interpretation

informed consent, release of info, test use / scoring and interpretation, proper diagnosis, multicultural issues, forensic evaluation

Morality

involves judgment or evaluation of some action (good, bad, right, wrong, should)

Confidentiality in group for minors according to ACA ethical standards

is not a right of children.

The problem with income sensitive or sliding fee scales (based on the client's ability to pay) is that

it is difficult to administer them in a fair manner.

The law requires clinicians to

keep progress notes.

In regard to state law and privileged communication, counselors must be aware that

laws are unclear and may vary from state to state.

Ethics state that a counselor should _______ all clients for group counseling

screen.

Roles and Relationships with Clients - Current Clients

sexual or romantic counselor-client interactions or relationships with current clients, their romantic partners, or their family members are prohibited

A married couple brings their two children to counseling for behavioral problems. The 14-year-old daughter stays out late and their 17-year-old son is using drugs. According to most marriage and family therapists the identified patient would be

the family.

Insurance payments are also called

third-party payments.

You are supervising a licensing candidate who is primarily interested in marriage and family counseling. You are very attracted to her and have sex with her. According to ethics guidelines

this is unethical.

A 39-year-old female secretary you are seeing in your assertiveness training group reveals that she is plotting to shoot her husband. Based on the Tarasoff case you should

warn the husband.

What is a Boundary Violation?

A serious breach from commonly accepted practices that results in harm to the client

A counselor wins the lottery and closes her practice without telling her clients. This counselor's course of action is best described as

abandonment.

A counselor who is alcoholic and suffering from burnout could best be described as

an impaired professional.

Most ethical dilemmas are related to

confidentiality.

In 2005, the American Counseling Association released the first revision of the ACA Code of Ethics in a decade. One major change was that

the code eliminated the phrase "dual relationships."

The landmark 1969 case, Tarasoff versus the Board of Regents of the University of California illuminated

the duty to warn a client in imminent danger.

As a professional counselor you develop a self-help software package for use by the general public. Ethics indicate that

the package must be initially designed for stand-alone usage as opposed to modifying a package requiring counselor support.

One major difference between the psychology versus the counseling movement seems to be that

the psychologists are working to eliminate practitioners with less than a doctorate, while the counselors are not.

A client asks you for classical psychoanalysis yet you have no training whatsoever in this area. If you agree to analyze the client, you are

unethical as this is misrepresentation.

A counselor is treating a woman for a mood disorder. The counselor has sex with the woman's daughter. According to the revised 2005 ACA Code of Ethics this is considered

unethical.

Counselor Unethical Behavior

violation of confidentiality, sexual activity with client, exceeding levels of professional competence, negligence, imposing your values on client, improper advertising, plagiarism, questionable financial arrangements (charging excessive fees), creating dependency on client, claiming "expertise" in area, conflicts of interest (dual relationships)

A 14-year-old male threatens to blow up his parents' garage because he has been grounded. You believe his threat is genuine. You should

warn the parents that their property is in danger.

Privileged communication refers to the fact that anything said to a counselor by a client

will not be divulged outside the counseling setting without the client's permission.

Assume that you have decided to refer a client elsewhere because you were unable to help her. The client insists upon seeing you. Ethics guidelines would dictate that

you are not obligated to continue the relationship.

A malpractice or liability insurance company is least likely to defend you if

you are sexually involved with a client.

You are a counselor in a state that does not legally support privileged communication. You refuse to testify in court. In this situation

you could be held in contempt of court.

What are the 12 required Contents of Informed Consent?

-The Therapeutic Process -Background of the Therapist -Costs involved with Therapy -Length of Therapy and Termination -Consultation with Colleagues -Interruptions in Therapy -Benefits and Risks of Treatment -Alternatives to Traditional Therapy -Tape Recording or Videotaping Sessions -Clients' Right to Access their Files -Rights Pertaining to Diagnostic Classifying -Nature and Purpose of Confidentiality

Client Rights

1. Know counselor qualifications 2. Informed consent (fees, time, services, etc.) 3. Confidentiality and limits 4. Ask questions/be informed of progress 5. Participate in goal setting and evaluation 6. Know emergency procedures 7. Request second opinion 8. Request copies of records 9. Report complaints to professional organization 10. Terminate at any time

Clients have a right to be informed about

1. Their therapist's qualifications 2. General general goals of counseling 3. Length of the therapeutic process. 4. Limits of confidentiality

Each year, approximately 31,000 U.S. citizens commit suicide with an alarming 2,000 individuals attempting suicide each day in the United States. Suicide often checks in as the second or third leading killer of teens. Men commit suicide more frequently than women, however, women attempt suicide far more often than men. It is accurate to say that

10 to 15% of all claims handled by the ACA liability insurance programs are related to suicide.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) was created by the American Psychiatric Association. The Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD) was created by the World Health Organization (WHO). Which counselor would most likely be required to utilize one of these guides to diagnose a client?

A counselor who wishes to secure insurance (i.e., third party) payments.

Define multiple or dual relationships and give examples.

A multiple relationship is one in which a practioner 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.

A counseling journal article should use documentation (i.e., references) that is based on

APA style.

Counselors' obligation regarding duty to warn vary state-by-state, counselors have a duty in general to protect clients from harming themselves or someone else and to protect clients from individuals who are threatening to harm them.

According to Wheeler and Bertram (2008) all sates legally require counselors to report any cases of suspected or known child abuse or neglect to the appropriate authorities. Almost all states also require counselors to report any suspicion of elder abuse as well as abuse of a person who is disabled or vulnerable due to severe mental illness. Protecting these vulnerable groups from possible harm overrides the needs for confidentiality. Counselors who fail to report these cases are likely to lose if they find themselves in a legal battle.

You are counseling a well-known celebrity who dies. According to the new 2005 ACA Ethical Code

Confidentially exists even after she dies.

What is Privacy?

Constitutional right of an individual to decide the time, place, manner, and extent of sharing information regarding oneself with others

What is the Intent of an Informed Consent Document?

Define boundaries and clarify the nature of the therapeutic relationship.

_______ is the leading cause of malpractice actions taken against counselors, therapists, and mental health providers.

Sexual misconduct.

What is important when contemplating a dual relationship?

These codes caution professioanl against any involvement with clients that might impair their judgement and objectivity, affect their ability to render effective service, or result in harm or exploitation to clients. Aplying an ethically based risk managed, decision making model when practitioners are analyzing a situation involving the pros and cons of a multiple relationship. Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and showing gratitude.

(T or F) Counselors must keep accurate records and document their activities as required by their employer and by the law.

True. Counselors must keep accurate records and document their activities as required by _______.

A statement of disclosure could include all except

a list of the courses the counselor took in graduate school.

You pass your exam and now have NCC status. During a staff meeting a clinical director explains to you that, from an ethical standpoint, your primary duty is to the agency. Most experts in the field of counselor education would

disagree inasmuch as professional ethics emphasize that your primary responsibility is to your clients.

When counselors state that privileged communication is "qualified," they actually mean that

exceptions may exist.

You have impeccable training and experience as a counseling supervisor. Now your brother finishes his master's degree in counseling and wants you to supervise him. According to ACA ethics you should

refer him to a trusted colleague trained in supervision who is willing to take your brother.

A woman comes to you for help with an eating disorder. You have no experience or training in this area. Ethically you should

refer this client to a colleague who is indeed trained and experienced with this type of client.

An exception to confidentiality could occur when a client is suicidal. Suicidal warning signs include

repeatedly joking about killing one's self, giving away prized possessions after one has been depressed for an extended period of time & a previous suicide attempt and a very detailed suicide plan for the future.

You have achieved the status of NCC. NBCC, nevertheless, feels you have violated professional ethics. NBCC can do any of the following except

revoke your state counseling license.

(COE) Section 7 - Research and Publications

rights of research participants, reporting results

Roles and Relationships with Clients - Former Clients

sexual or romantic counselor-client interactions or relationships with former clients, their romantic partners, or their partners, or their family members are prohibited for a period of 5 years following the last professional contact and only after consideration to avoid potential exploitation and/or harm to the former client

Many ethical codes state that dual or multiple relationships

should be avoided whenever possible.

The 2005 ACA code addresses end-of-life issues since these issues are getting a high degree of social attention (e.g., the Oregon assisted suicide law and the Terri Schiavo right-to-die case). The new code

suggests that counselors who are helping terminally ill clients who are thinking of hastening their own death would have the option of breaking or not breaking confidentiality.

You have attempted to help a client for over two years with little or no success. You should

terminate the relationship and initiate an appropriate referral.

Retain counseling records for at least 5 years after the counseling relationship has ended, even if the client has died.

Certified counselors must always provide clients with acceptable referral options if they have to prematurely terminate the counseling relationship.

How does Malpractice relate to Abandonment?

Client is entitled to proper care by the contracted therapist Abandonment may bring on malpractice due to professional negligence If client is terminated without referral to another physician and harm resulted, the therapist is guilty of abandonment

What mental capacity is required for a client to give Informed Consent?

Client must be of legal age Client must be psychologically and legally able to Consent

How are clients affected by having a sexual relationship with a therapist?

Clients are adversely affected, with the harm ranging from mistrust of opposite gender relationships to hospitalization and, in some cases, suicide, guilt, depression, anger, feeling of rejection, and low self esteem.

What is Role Blending?

Combining Roles and Responsibilities Ex. Therapist and Lover

What was Jaffe vs. Redmond?

Communications between licensed psychotherapists and their clients are privileged and therefore protected from forced disclosure in cases arising under federal law

Counselors must advocate on behalf of clients, with their consent, to help them overcome barriers to ____, and encourage clients to __________ when possible.

Counselors must ___________, with their consent, to help them overcome barriers to improvement, and encourage clients to advocate on their own behalf __________.

Counselors must obtain clients consent before sharing confidential information with treatment teams or third-party payers

Counselors must allow clients to have "reasonable access" to their records and answer any questions clients have about the information found therein.

Counselors must ensure that the problem to be addressed and the goals to be worked toward during the consultation process are constructed in collaboration with the consultee

Counselors must make culturally sensitive diagnoses of mental disorders

Counselors must consider abstaining from making a diagnosis if they think it would damage the clients in any way

Counselors must make sure the assessments they use with clients are normed on their population. If not, the counselor must make note of it.

Counselors must only function in a consultative capacity in areas for which they are trained and qualified.

Counselors must obtain informed consent before providing consultation

Counselors must refuse to perform forensic evaluations on current or former clients, as well as refuse to accept clients who are currently or have been previously evaluated for forensic purposes.

Counselors must try to resolve any conflicts that arise between the Code of Ethics and the law. When unable to do so, counselors may follow the law.

Counselors must obtain consent before recording a session with a client, observing a session with a client, or showing a recorded session to an outside party.

Counselors must use techniques that are "grounded in theory and/or have an empirical or scientific foundation" or else label their techniques as "developing"/"unproven" and make sure to discuss and possible risks with the client.

What is Malpractice?

"Bad Practice" Failure to render professional services Failure to exercise the degree of skill normally expected in a similar situation

What are Progress Notes?

Basic, Required part of the clinical records Behavioral in nature Address what people say and do

How should a therapist respond to a Suicidal or Self-Harming Client?

Break confidentiality only when they have good reason to suspect suicidal behavior

What is Boundary Crossing?

Departure from commonly accepted practices that could potentially benefit clients

When is it appropriate to receive a gift from a Client?

Depends upon the situation The therapist should explore why the client wishes to give a gift Analyze factors such as when is it occurring in therapy what are the cultural motivations what are my motivations for taking the gift

You leave your practice to study mental health treatment in another country. Dr. Kline, another licensed counselor, is now the custodian of your records. To conform with current ethical standards this was clearly explained in your informed consent brochure given to the client during the first visit. The clients have Dr. Kline's contact information. According to the new ethics regarding transfer plans

Dr. Kline should contact each client when he receives the record.

Dr. X recommends to his agency clients that he would rather counsel them in his private practice. Ethically speaking

Dr. X is diverting agency clients to his practice and this is unethical.

(T or F) Counselors must refrain from bartering unless it is fair, suggested by the client, and other clients don't know about it.

False. Counselors must ___________ unless it is fair, suggested by the client, and an admissible convention in the community.

(T or F) Counselors must avoid any interaction with clients outside of the professional context.

False. Counselors must avoid any__________________unless the interaction could be potentially beneficial (attending a wedding, graduation, or funeral). If a counselor decides to engage in potentially beneficial interaction, they must gain consent from the client and document their reasoning in writing.

What is Confidentiality?

Foundation of safe therapy Prohibition of therapist to disclose confidential communication to any third party unless legally permitted or mandated

What is the goal of the Informed Consent Process?

Give clients adequate and continuous information so that they may anticipate what they will be asked to consent to in treatment.

Describe boundary management issues in rural areas or small communities.

In small communities, including rural communities, mental health practitioners and school counselors have far greater challenges dealing with multiple relationships than those who work in urban areas. Practitioners who work in small communities often have to blend several professional roles and functions.

What is the purpose of Informed Consent?

Increase the chances that the client will become involved, educated, and a willing participant in own therapy

What is the Difference between Boundaries in Small Towns as compared to Urban Areas?

It is harder to avoid non-professional relationships in a small town.

How does HIV apply to client/therapist privilege?

It is protected so long as there is no foreseeable danger to other individuals

What is Privileged Communication?

Legal concept that bars the disclosure of confidential communication in a legal proceeding

The agency you work for insists that you diagnose every client. Since this is in violation of the new ACA ethics this would qualify as "negative conditions." You could handle this by

Meeting with your supervisor and executive director of the agency and discussing other ways to secure funding that go beyond DSM reimbursement. Advocate for the client by explaining to the insurance company asking for the diagnosis that in some cases it is best that a diagnosis not be given. You could even teach the client to advocate for herself by having her inform the insurance company that a diagnosis might not be in her best interest & Show your supervisor, executive director, or insurance company/managed care firm the actual ACA Code of Ethics so they can see it in writing that the code stipulates that "Counselors may refrain from making and/or reporting a diagnosis if they believe it would cause harm."

When is a Sexual Relationship appropriate with a Client?

Never

What is Lazarus' position on Boundaries?

No code of ethics of any professional organization states that nonsexual dual relationships are unethical, and most acknowledge that some are unavoidable

What is Voluntariness in relation to the legal aspects of Informed Consent?

Person giving consent is acting freely in the decision-making process Client is legally and psychologically able to give consent

2 types of Ethics

Personal (conforms to moral standards); Professional (standards of conduct (i.e, ACA))

What are Multiple Relationships?

Practitioner is in a Professional role with a person in addition to another role with the same client. Multiple relationships exist and overlap Ex. Therapist, Instructor, Relative

What are Dual Relationships?

Practitioner is in a Professional role with a person in addition to another role with the same client. Two roles exist

How does Malpractice relate to the Competence of the Therapist?

Professional negligence can result from unjustified departure from usual practice or failing to exercise due care in fulfilling responsibilities

Ensure that clients have access to other professionals who charge standard prices during and after involvement in brief counselings

Provide clients who they are counseling long-distance with community mental health resources in their area.

What are Process Notes?

Psychotherapy Notes Deal with Client reactions such as transference Therapist's subjective impressions of the client

Confidentiality

Refers primarily to counselors' ethical duty to keep client disclosures private

What are the risks in becoming sexually involved with a client?

Sexual relationships with clients are clearly unethical, and all of the major professional ethics codes have specific prohibitions against them. Also, the therapist could have criminal action or civil action taken against them, if they are guilty of sexual misconduct with clients.

How do Boundaries relate to Small Towns?

Small towns often force role blending, multiple and dual relationships. Therapists should take special care.

provide a manual for any "self-help/stand-alone computer software for use by the general public," and ensure that the software is suitable for all intended users.

Technology-assisted distance counseling - any counseling that occurs over the phone or online via email, video, or chat programs.

Describe issues associated with being sexually attracted to a client.

The counselor may have to seek professional support during these times or at least consult a colleague, this depends on the situation. The counselor has to be very careful and objective and should avoid a multiple relationship in this case.

What are the Safeguards against Malpractice Liability in Suicidal Cases?

The therapists have a legal duty to make assessments from an informed position and to carry out their professional obligations in a manner comparable to what other reasonable professionals would do in a similar circumstance. Therapist does not have to be right all the time.

What is Comprehension of Information in relation to the legal aspects of Informed Consent?

Therapists must present information in a clear way Therapist must make sure the client understands the information given

How do Boundaries relate to Urban Areas?

Urban areas are easier to remain separate from clients and potential clients.

In terms of the previous question:

Using a mental health professional on staff or at another facility is preferable to using a lawyer or a CPA.

How does Privacy apply to the disclosure of confidential information in cases involving HIV?

When clients disclose they have a disease commonly known to be communicable and life-threatening, counselors are justified in disclosing information to third parties at high risk for contracting the disease. The diagnosis must be confirmed, and client must have no intention of contacting the individuals threatened.

Under what circumstances should a therapist consult with colleagues or specialists?

When the client complains of physical symptoms; facing an ethical problem, or when working with a client for an extended period of time and losing objectivity.

What is Tarasoff?

Woman who died because a therapist failed to warn her of danger from his client. Duty to warn a potential victim

According to the Family Educational Rights and Privacy Act (FERPA) of 1974 (also known as the Buckley Amendment)

a parent can see his or her daughter's middle school record & an 18-year-old college student can view his or her own educational record.

Marcus, a therapist in a community agency, recently divorced his wife and seems to be harboring anger towards women in general. His colleagues, who have noticed a change in his attitude and behavior lately, have encouraged him to seek personal counseling to work through his issues. They are

acting ethically by recommending counseling for Marcus; as counselors, they recognize that personal issues that have not been worked through are likely to be projected onto clients.

5 Ethical Principles To Guide Ethical Choices

beneficence, nonmaleficence, autonomy, justice, fidelity

Informed Consent

clients have a right to be informed about their therapy and to make decisions pertaining to it

(COE) Section 4 - Professional Relationships

colleagues, employers, employees

Sharing Information - Privacy

constitutional right; people have a constitutional right to decide the time, circumstance, place manner and extent of sharing oneself - or NOT - with others

(COE) Section 6 - Teaching, training, supervision, expectations and responsibilities of:

counselor education, student in training, counselor ed programs

Sharing Information

counselors have a duty to protect the public; overrides obligation to confidentiality, privacy, privileged communication, confidentiality

Justice

fairness

(COE) Section 1 - Counseling Relationship

fees, bartering, termination, professional responsibility to clients and their welfare

Law

governing standards established to ensure moral and legal justice; minimum legally enforced values; does not dictate what is ETHICAL but what is LEGAL

Privileged communication does not apply to

group counseling, couples counseling, family therapy, and child and adolescent therapy.

(COE) Section 8 - Resolution of ethical issues

handle conflict, suspected violations, cooperation with ethics committee

Ethical Decision-Making Model

identify the problem, identify potential issues involved, review relevant ethical guidelines (Code, Principles), consult (supervisor, professional peers), consider potential consequences and courses of action, list consequences of various decisions, choose best course of action

Client Records

identifying / intake info, assessment info, treatment plan, case notes, termination summary, other: consents, correspondence, admin problems, rational for unusual client intervention, etc.

Professional Needs and Values

in the counseling relationship, counselors are aware of the intimacy, power, and responsibilities inherent in the counseling relationship, maintain respect for clients, and avoid actions that seek to meet their personal needs at the expense of clients

Sharing Information - Privileged Communication

legal right, regulates privacy and confidentiality by protecting individual from having confidential information disclosed without permission

Over 7,000 ACA members are now in private practice. The consensus among experts is that

managed care companies are becoming easier to work with.

Dual Relationships

occurs when there is a professional relationship AND a secondary relationship that is of a financial, social, business, friendship or intimate nature

Ethics

principles and standards that govern relationships between individuals; concerned with human contact and moral decision making

(COE) Section 3 - Professional Responsibility

professional competence, credentials, advertising, solicitation, public responsibility

One impetus for counselor licensing was that

psychology licensure bodies sought to restrict the practice of counselors so counselors could not receive third party payments from insurance and managed care companies.

(COE) Section 2 - Confidentiality, privacy & and privileged communication

records, minor or incompetent client, consultation, research and training

(T or F) Counselors must obtain informed consent (verbally) from clients.

False. Counselors must obtain informed consent (verbally and written) from clients.

Internet - Take appropriate steps to confirm the identity of the client

Internet - Gain consent (and confirm the identity) of a parent/legal guardian when counseling minors

Internet - work with clients to find suitable, local mental health professionals and hotline numbers should the client need to contact someone in an emergency situation.

Internet - Inform clients of locations in their community that provide free access to the internet, if appropriate

Internet - provide alternate contact options

Internet - discuss limitations of technology-assisted distance counseling, such as the possibility that statements may be misinterpreted "when visual cues do not exist" and how to handle those situations if they occur.

As a private practice counselor your _______ would be most important in terms of filing claims.

NPI number.

Counselors must recognize that by accepting employment at an organization, they are indicating their accordance with that organization's practices and procedures.

Notify their employer about any improper or unethical organizational practices that negatively affect clients, or counselors' ability to provide services, and work to change those policies.

A counselor is seeing a client on a managed care plan. Unfortunately, the client has used up her maximum number of sessions for the year. The counselor is convinced that the client is in need of additional counseling, however, the counselor's agency will not allow him to see her for any additional sessions. The best plan of action would be for the counselor to

Refer the client for continued counseling to a practitioner who will see the client whether or not she has managed care benefits.

The ACA code of Ethics serve as

Serve as a basis for ethical behavior, providing counselors with a foundation and model for behavior, a useful resource when ethical questions arise, and a procedure for filing and responding to ethical complaints.

(T or F) Counselors must gain consent from the client before changing roles in the counseling relationship (e.g., switching from acting as an individual counselor to a family counselor).

True. Counselors must ____________ before changing roles in the counseling relationship (e.g., switching from acting as an individual counselor to a family counselor).

(T or F) Counselors must obtain assent from those unable to give informed consent.

True. Counselors must obtain ________ from those unable to give informed consent.

(T or F) Counselors must seek permission to make contact and work collaboratively with any additional counselors or mental health professionals who their client is seeing.

True.(T or F) Counselors must seek permission to make contact and work collaboratively with any additional _________or __________ who their client is seeing.

(T or F) Counselors must assist terminally ill clients in receiving excellent end-of-life care and being involved in educated decision making regarding their care.

True.Counselors must assist terminally ill clients in receiving __________ and being involved in ____________regarding their care.

You are counseling a 29-year-old man in your private practice who is seeing a primary care physician (PCP) for severe headaches.

You are not required to contact the PCP; however, attempting to secure permission to do so from your client would be considered the ideal course of action.

subpoena

a legal document that orders a person to appear in court to serve as a witness or to provide the court with certain documents. Always consult with an attorney before providing any information to the court in order to best protect the client's confidentiality and determine if privileged communication applies. Counselor should also contact client's attorney to ascertain how the client would like the counselor to proceed. If the client is agreeable to the counselor providing the requested information, the counselor should ask the client to sign a written authorization. IF the client does NOT want the counselor to divulge information, counselor should ask the client's attorney file a motion to quash the subpoena. At this point, the court will normally decide whether the counselor's information is necessary, and, if so, will provide the counselor with a court order demanding the release of the information. IF a counselor received both a subpoena and a court order, he or she must comply or be held in contempt of court. Under ACA Code of Ethics, if counselors have to share private information, they should only disclose information germane to the case and nothing more.

Privileged communication

a legal term that protects certain counselor-client communication in the court systems. In many states counselors, like doctors, are protected under privileged communication from having to reveal information about a client in a legal proceeding, even if they receive a subpoena. Both confidentiality and privileged communication belong to the client, meaning that the client can choose to waive his or her right to either, allowing the counselor to ethically and legally disclose private information about the client.

The new ACA ethical requirement to have a transfer plan in writing would apply to

a situation in which a counselor became disabled, a situation in which a counselor died & a situation where a counselor moved to another state.

NBCC has developed a Code of Ethics to help counselors behave in a professional manner. The code is divided into a preamble and seven sections. The first section (i.e., Section A) warns against stereotyping and discrimination. All of the following would be examples of stereotyping and discrimination except

advising a client to consider switching his college major based on your clinical judgment as well as the results from an extensive test battery.

A 16-year-old girl threatens to kill herself and you fail to inform her parents. Your behavior as a counselor is best described as

an example of negligence, which is a failure to perform a duty, which in this instance is an obligation to protect the client.

Traditionally, _______ counseling has caused the most ethical concerns.

behavioral.

A man has a rare, highly contagious disease that is fatal. He is keeping it a secret and insists that he will never tell his wife. You should

break confidentiality and tell his wife.

The new ACA 2005 Code of Ethics forbids sexual or romantic counselor-client interactions or relationships with current clients, as did the old code. The old 1995 Code stipulated that a counselor would need to wait two years after termination before entering into a romantic relationship with a former client. The new regulations

changed 2 years to 5 years.

A client needs counseling but can afford only $5 per session. As a private practitioner you charge $75 per hour. You should

consider the client's financial status and the locality and offer her a reduced rate.

APA is to psychologist as ACA is to

counselor.

You find yourself sexually attracted to a client. This is known as

countertransference.

A counselor reveals information that is extremely damaging to a client's reputation. This counselor could be accused of

defamation

Your sexual attraction toward your client is hindering the counseling process. You should

explain this to the client and then refer the client to another provider.

A client wants his records sent to a psychiatrist he is seeing. You should

first have the client sign a dated release of information form that stipulates whether the information can be released once (or for what period of time it can be released) and then you can send the information.

You are counseling your first cousin for depression. This is

generally unethical as it would constitute a dual or socalled multiple relationship.

Your agency uses a collection agency when clients don't pay their bills. You should

inform the client of this before the counseling begins.

You are a middle school counselor at a public school. A child is threatening to kill another student and admonishes you to keep it a secret. According to the ethical principle of minimal disclosure the best course of action would be to

inform the parents of the student in danger, inform the principal, and call the police immediately, discussing only material related to the threat.

A counselor is counseling an executive secretary. The counselor notes that he is writing a book and explains to the client that he will see her for free if she types the manuscript. This is

known as bartering and unethical as described here.

You are treating a man who suffers from panic disorder. His panic attacks are so severe he cannot drive to work. After just three sessions he is not only driving to work but has taken up sky diving to demonstrate his progress over his fear. You would love to put his testimonial on your brochure to show how adept you are at treating this affliction. You should

not ask him for a testimonial since it would constitute an ethics violation.

You are seeing a husband and wife for marriage counseling. During one of the sessions you decide to see them separately. The husband tells you he has seen an attorney because he is filing for divorce. He has not told his wife and indicates that he will not do so. You feel the wife has a right to know this because it will help her plan for the future. You should

only tell his wife if he gives you permission.