Ethics of Counseling Exam 2

Licensure

: the most rigorous form of regulation in that only those who are licensed may practice that profession in a state.

Counseling Multiple Clients

Confidentiality cannot be guaranteed in group counseling. Very difficult to enforce. Cannot be guaranteed in couples, or family counseling. How to deal with family secrets. Must make clear to both marital partners at the onset the limitations of confidentiality and how you will handle secrets (Standard B.4).

Diligence:

consistent attentiveness to the client's needs; putting client welfare first and foremost. • *Counselor incompetence is the second most frequently reported area of ethical complaints (after dual relationships with clients) (Neukrug, Millikin, & Walden, 2001).

Privileged communication

laws protect clients from having confidential communications with their counselors disclosed in a court of law without their permission.

Privacy

the right of persons to decide what information about themselves will be shared with or withheld from others.

Civil Law Suits

• : lawsuits are civil which means that one citizen has to sue another for action to be taken against a person who does something wrong.

Clinical Case Notes

• ACA Code notes that counselors do keep records. • A matter of routine practice to keep notes. • Failure to do so could be considered unprofessional practice and may be called to explain why one does not keep notes. • Still have to give testimony if you did not have notes if someone had a legal right to that information. • Assume these notes will be read.

Records

• Any "physical" recording made of information related to a counselor's professional practice. • Referred to as clinical case notes. • Others: o Appointment books, billing and payment records, copies of correspondence, intake forms, assessments, other routine papers. o Audio, video-recordings of clients. • Primary purpose: to assist you in providing clients the best possible counseling services.

Court-Ordered Disclosures

• Must disclose confidential information when ordered to do so by a court. • If relationship is privileged, either the client or the counselor will asset the privilege. • No privilege exist cases: counselors should ask the court not to require the disclosure and explain the potential harm that could be done to the counseling relationship. • If disclosure still ordered, only essential information should be revealed. • If ordered by a judge to reveal information, counselors should not worry that clients may sue them for violating their privacy. • Complying with a judge's order is a defense to any charge of wrongdoing (Prosser, 1971). • Subpoena may not be valid. Do not respond until consultation with a lawyer and he has advised that course of action.

Diversity Considerations in Counseling Competence

• Recognize diversity in society and develop intercultural competence. • If not properly trained and competent to work with culturally diverse clients, you might be practicing unethically if you attempt to provide services to these clients. • There is an abundance of literature available for multicultural issues. • Seek out cultural experience different from you own and participate in some of these experiences.

Information Technologies

• Technology presents counselors with a myriad of opportunities for keeping current and improving their competence as practitioners. • Advances are so rapid that it is hard to keep up with the changes from one day to the next. • ACA, NBCC, CACREP and many other counseling organizations all have web sites. • Some counselors provide counseling over the internet and that creates another whole area of ethical issues. • *Drawbacks: no reliable method of regulating services offered, ensuring competence of the providers, or protecting consumers from ill-advised Internet based services (Wilson, Jencius, & Duncan, 1997).

Counselor Preparation Issues

• To be competent, counselors are expected to 'gain knowledge, personal awareness, sensitivity, and skills pertinent to working with a diverse client population" (C. 2. a, ACA code, 2005). • Responsibility for producing competent practitioners lies with - counselor educators and supervisors. • Select and admit individuals to graduate programs who are likely to succeed at developing the skills, knowledge, and characteristics needed to become effective counselors. • Academic ability is one important factor.

Purposes of Records

• Transfer information from one health care provider to the next health care provider. • Create a history of client's diagnosis, treatment, and recovery. • Helps to render better services to clients. • Allows counselor to summarize interactions with client and record plans for future sessions. • Kept for counselor benefit: documentation of steps taken in emergency, crisis situations. • Business records, expenses for tax purposes.

Jaffee vs. Redmond (1996)

• U.S. Supreme Court ruled: • Communications between licensed psychotherapists and their clients are privileged and therefore protected from forced disclosure in cases arising under federal law. • 7 - 2 decision in this case represented a victory for mental health organizations because it extended the confidentiality privilege. • The Supreme Court upheld the appellate courts decision, clarifying for all FEDERAL COURT CASES, both civil and criminal, the existence of the privilege • privileged communication • Supreme Court Ruling • "effective psychotherapy depends upon a atmosphere of confidence and trust in which the patient is willing to make frank and complete disclosure of facts, emotions, memories, and fears." • High court's ruling recognizes the societal value of psychotherapy and the importance of confidentiality to successful treatment

Forseeability

• has to do with whether the professional knew or should have known that the professional's actions would result in a specific outcome.

Actual cause

•: a person actually caused the injury of another person.

Family Education Rights and Privacy Act (FERPA)

"Buckley Amendment" • Federal law protecting privacy of student education records. • *Affects all public educational institutions and any private parochial educational institution that receives federal funding in some form or another.. • Penalty: loss of all funding. Individuals cannot bring lawsuits under FERPA. • Parents of minor students and students who are 18 or older or who are in college have two rights: o To inspect and review their education records and to challenge the contents to ensure the records are not inaccurate or misleading. o To have their written authorization obtained before copies of their education records can be transferred to any third party.

• *Purpose of boundaries:

"to protect the welfare of clients who are in a vulnerable position in the therapeutic relationship." Set limits on contact, time, place, self-disclosure, gifts o "do NO harm" • Boundaries Help understand the parameters of the professional relationship.

Exceptions to Confidentiality and Privileged Communication

-death of client -Sharing Information with Subordinates or Fellow Professionals -Protecting Someone Who is in Danger

Three important Functions of Maintaining Distance

1). It can help professionals cope efficiently with difficult situations by keeping them from becoming emotionally overwhelmed. 2). Proper distance can help in promoting a professional's respect for client autonomy. 3). It can help a professional to maintain objectivity.

Suits for Disclosure

• Clients have a right to expect confidentiality and privilege. • Counselors have a legal duty to maintain the privacy of their clients. • If a counselor discloses without legal exceptions to confidentiality and privilege, client could sue the counselor for malpractice. • Crucial that you know the exceptions to confidentiality and privileged communications and how to apply those exceptions in your practice.

Subpoenas

• Legal documents that require counselors to produce copies of records, appear for a deposition, court hearing, or trial; or appear and bring their records with them (Cottone, & Tarvydas, 2003). • They are official court documents and cannot be ignored. All citizens must obey court documents. • Alternative: to appeal to a higher court. • Such appeals must be immediately filed by a lawyer. • Discovery: the process whereby attorneys have the right to ask for and receive information relevant to their case before the case is tried (Swenson, 1997).

Invasion of time boundaries:

• Phone calls • Trying to extend sessions • No shows • Late arrivals

Arguments for Record Keeping

• Record keeping is a set standard by many professional organizations (ACA, APA, AAMFT, NASW). • Clinical record can serve as a defense against malpractice suits. • Can serve client by reflecting the client's condition at a certain time. EXP: client may be alleging damage and require support of your records. • Records document treatment received. • Assist client if you are unavailable or if client transfers to new therapist. • Can improve your psychotherapy skills. Impossible for you to recall all significant material week to week. • Records can help in the management of your practice • Good records can help protect your license if charges are ever filed against you • Good records can assist you if you are charged with an ethical violation • Your judgment can be evaluated retrospectively. The record should produce evidence of care in judgment. • Health insurance companies are becoming more aggressive in the area of peer review and increasingly making third-party payments contingent upon retroactive review of the complete record for clients. Incomplete records = denied reimbursement. • Federal/state laws may require adequate record keeping

Rationale for Privileged Communication

• Revelation of embarrassing, sensitive, secrets, clients must be assured that the content of their counseling sessions will not be revealed without their permission. • Counselor-client privilege of some type existed in 44 of 45 states that licensed counselors in 2000 (Glosoff, herlihy, & Spence, 2000). • Psychologist-client privilege statues existed in all 50 states. • INVESTIGATE THE STATUES OF THE STATE IN WHICH YOU PRACTICE TO DETERMINE WHETHER YOUR INTERACTIONS WITH CLIENTS ENJOY PRIVILEGE. • If your state does not offer statutory privilege, inform your clients that you will keep confidential the content of your counseling sessions with them, but one of the exceptions would be if a judge orders you to disclose information.

Types of Sexual Abuse in Therapy:

• Sexual touch as therapy • Learning to love as therapy • Exploring sexual identity • Fatal attraction (transference and counter-transference dominates) • Becoming romantically involved • Brief loss of control • Bonding and other types of closeness • Closeness between women is different • Nurturance

Duty to Warn Intended Victims

• Tarasoff v. Regents of California: case in which the duty to warn an identifiable or foreseeable victim of a dangerous client. • "when a psychotherapist determines, or pursuant to the standards of his profession should determine, that a patient presents a serious danger or violence to others, the therapist incurs an obligation to use reasonable care to protect the foreseeable victim from such danger (McClarren, 1987,p. 273). • Tarasoff doctrine has not been accepted or applied in every jurisdiction in the United States, counselors have chosen to incorporate it into the ACA Code of Ethics and generally assume that the concept is a national legal requirement. • Texas is the only jurisdiction that ha specifically rejected the Tarasoff duty to warn doctrine. • Implication for you: when you determine that a client might harm an identifiable or foreseeable person, you must directly or indirectly warn that individual of the danger, except in Texas.

Rationale for Confidentiality

• Universally viewed as essential to the counseling relationship. • Four premises (Bok, 1983): • Respect for autonomy: self-determination. • Respect for human relationships: secrets that certain type of relationships entail. • Pledge of silence: offer of confidentiality extended by counselor to the client. • Utility: confidentiality in counseling relationships is useful to society, without it clients would be reluctant to seek help.

Suicidal Clients

• When a client threatens to commit suicide, an ethical duty arises to protect the client from harm to self. • Ethical standard that applies to clients who pose a danger to others applies to suicidal clients as well. • Confidentiality requirements are waived when disclosure is necessary to protect clients or others from serious and foreseeable harm (B.2.a). • Evaluating and managing suicide risk is one of the most stressful situations you will encounter in your work (Corey et. Al., 2007).

May allege:

• malpractice, negligent infliction of emotional distress, battery, intentional infliction of emotional distress, fraudulent misrepresentation, breach of contract, breach of warranty, and spouse loss of consortium (love, companionship, and services).

Glosoff 9 areas most frequently listed in state statues:

1. Cases of dispute between counselor and client. 2. Client raises issue of mental conditioning in legal proceedings. 3. Client's condition poses a danger to self or others. 4. Cases of child abuse or neglect (in addition to mandated reporting laws). 5. When counselor has knowledge that client is contemplating commission of a crime. 6. Court ordered psychological evaluations. 7. Purpose of involuntary hospitalization. 8. Counselor has knowledge that client has been a victim of a crime. 9. Cases of harm to vulnerable adults.

Decision Making Model (Herlihy & Corey, 1997

1. Determine if the potential dual relationship is avoidable or unavoidable. 2. Have a full and open discussion with the client, exploring the possible problems and benefits. 3. Counselor must judge whether the benefits outweigh the risks or whether the reverse is true. 4. If risk of harm to client is greater than potential benefits, decline to enter the dual relationship and refer if needed. Provide an explanation to the client so that they understand the rationale for not proceeding with the problematic part of the dual relationship.

Proximate cause

: has to do with whether or not the individual would have been injured had it

Credentialing

: method of identifying individuals by occupational group (Sweeney, 1995). •

Certification

: term used when a title such as "professional counselor" can be used only by those who are certified, but anyone can practice the profession without being certified.

Confidentiality

an ethical concept referring to the counselor's obligation to respect the client's privacy and to our promise to clients that the information they reveal during counseling will be protected from disclosure without their consent.

Professional distance

defined as a reasonable response in pursuing professional values by avoiding inappropriate personal involvements while maintaining a sense of personal engagement and responsibility. • Under-distancing: the undesirable interference of personal values with professional standards. • Over-distancing: the equally undesirable loss of personal involvement, whether in the form of denying one's responsibility for one's actions or in the form of lacking desirable forms of caring about clients and community.

*Boundary crossing:

departure from a commonly accepted practice that occurs to benefit a client. Boundary is shifted to meet the needs of a particular client at a particular moment. • Boundary violation: a serous breach that causes harm. • From ETHICAL STANDPOINT: "occasional boundary crossings can be justified when there is benefit to the client and very little risk of harm." • Example of boundary crossing: client asks you to come to graduation or go to lunch with client and then you start disclosing to much info to the client

Registration

form of governmental regulation in which members of a profession must "sign up" with the government if they practice the profession in the state, but anyone may sign the registry without a review of their credentials (Anderson & Swanson, 1994).

Warning signs of counselor impairment:

• o Deterioration in personal relationships, including marital problems and family dysfunction. o Becoming isolated and withdrawn from others. o Feelings of disillusionment with the profession. o Emotional distancing during counseling sessions. o Alcohol and drug abuse. o Changes in work habits such as increased tardiness and absenteeism. o Procedural errors and sloppy record keeping.

Clients with AIDS or Who Are HIV-Positive

• "When a counselor receives information confirming that a client has a disease commonly known to be both communicable and life threatening, the counselor may be justified in disclosing information to identifiable third parties, if they are know to be at demonstrable and high risk of contracting the disease" • (ACA Code of Ethics) Contagious, Life-Threatening Diseases.... • According to ethical guidelines, counselors are justified in disclosing, but are not necessarily required to disclose, information to an endangered third party. • Weigh factors and determine your own stance regarding this issue.

Administrative records

• *Any type of records that would not be considered recordings or clinical case notes. • All setting require. • Type of agency and setting determine nature of records kept. • Must conform to standards of setting you are in. • In most businesses not considered confidential yet the very fact that someone has applied for counseling services is a confidential matter. • Business records that reveal the identity of individuals who have had contact with the agency must be treated as confidential and must be protected in the same way al clinical case notes.

Early Warning Signs of Boundary Crossings

• Actively seeking opportunities to be with a client outside the professional setting. • Anticipating, with excitement, a certain client's visitation. • Expecting that a client should volunteer to do favors for you (e.g., get you a better deal from his/her business). • Viewing a client as in a position to advance your own position and fantasizing as to how that would play out. • Wishing that a client were not a client and, instead, in some other type of relationship with you (your best friend or business partner). • Disclosing considerable detail about your own life to a client and expecting interest or nurturing in return. • Trying to influence a client's hobbies, political views, or other personal choices that have no direct relevance. • Allowing a client to take undue advantage without confrontation (e.g., missing too many appointments). • Relying on your client's presence or praise to boost your self-esteem. • Giving in to a client's requests and perspectives on issues from fear that he or she will otherwise leave therapy. • Feeling entitled to most of the credit if your client improves, especially if marked achievement is attained while under your care. • Viewing clients as the central people in your life. • Greatly resisting termination of a client even though the indicators for it are clear. • Believing that you are the only person who can help a particular client. • Noticing that the pattern of interactions with a client is becoming increasingly irrelevant to the therapeutic goals.

Health Insurance Portability and Accountability Act Enacted on August 21, 1996.

• Applies only to organizations and individuals who transmit health care information in electronic form in connection with a health care transaction. • Recommended that mental health care organizations or private practitioners comply with HIPPA requirements. • Each practice needs to designate privacy officer: o Train employees how to handle confidential information, ensure practices to protect client privacy, ensure proper forms are used by counselors and other health care personnel. • HIPPA is a federal law and overrides state laws that are more lax.

Origins of Confidentiality

• Beginning of 19'th century, mental illness viewed as mystical and demonic. • 1800's significant strides made in understanding mental illness. • 1960's deinstutionalization of mentally ill bought these individuals back into contact with society. • Social stigma associated with those who sought help. Today still there is still a shame that is associated with seeking the services of a mental health professional. • Easy to understand the need for confidentiality in this type of climate.

BIOP:

• Behavior: behavioral observations • Intervention: interventions used by counselor during session • Outcome: outcome of interventions and sessions. • Plans: treatment planning for next sessions, homework, next session date.

Clients with AIDS or Who Are HIV-Positive Arguments for maintaining confidentiality:

• Breaches of confidentiality are counter-therapeutic when working with high risk clients who have a high level of mistrust due to discrimination against them (gay men, prostitutes, and intravenous drug users), exposure to AIDS does not carry the same level of risk that it once did; if clients confidentiality is compromised, they may discontinue counseling.

Self Disclosure

• Can be a powerful intervention that can strengthen the therapeutic alliance. • Learn the skill of use, be able to articulate your rationale for using it in the counseling process, and also understand it as an ethical issue. • Self-disclosure is ethically appropriate if done for the client's benefit within the context of the therapeutic process (Smith & Fitzpatrick, 1995). • Considered unethical when used to meet the counselor's own needs for intimacy or understanding. • Topics considered inappropriate: details of current stressor's, personal fantasies or dreams, and social and or financial circumstances. • Inappropriate counselor-self-disclosure, more than any other kind of boundary violations, is likely to precede counselor-client sexual intimacy (Simon, 1991).

Other Legal Exceptions

• Clients waive their privilege then the bring lawsuits claiming emotional damage. • Person accused of damaging the client must be given an opportunity in a court proceeding to cross-examiner the counselor regarding the nature and extent of the damage. • Privilege is generally waived in civil commitment proceedings for those individuals who are being evaluated by a court to determine whether they should be involuntarily committed to a psychiatric hospital. • WHEN IN DOUBT ABOUT YOUR OBLIGATIONS REGARDING CONFIDENTIALITY OR PRIVILEGED COMMUNICATION, CONSULT, CONSULT, CONSULT!!!

Clients with AIDS or Who Are HIV-Positive Arguments for Disclosure:

• Confidentiality is not an end in itself. • The need to protect someone who may be at risk of contracting a fatal disease creates a higher duty. • With AIDS having reached epidemic proportions, mental health professionals have an obligation to do their part to protect the health and welfare of society at large when AIDS clients are putting others at risk.

Arguments Against Record Keeping

• Confidentiality maintained better by not keeping records • Some clients request that their therapists keep no records • Therapist fear someone (e.g., client, attorney, insurance company) might take issue with what is stated in the record • Impossible to write everything down that a client says, therefore therapists who keeps records may have to justify why something from a session did not get recorded • Some keep process notes and argue that working notes do not belong in a client's record and any disclosure is an invasion of the therapist's privacy • Accurate record keeping is time consuming • No record keeping is better than an inadequate record • Some seem unsure of what is contained in a good record • Records are only to protect the therapist in litigation. Since the therapist did not intend to do anything wrong, there is no need to keep records • "It is in my client's best interest not to keep records" • One therapist said that keeping records will make him accountable, and he wasn't going to be accountable to anyone!

Legal Protections for Counselors in Disputes

• Counselors may reveal confidential information when it is necessary to defend themselves against charges brought by clients. • Law of privileged communication requires that clients waive their privilege when they bring complaints or malpractice lawsuits against their counselors (Knapp & VandleCreek, 1987).

*DAP:

• Data: objective description of what occurred during session. • Assessment: interpretations based on data, in context of presenting problem and treatment plan • Plan: What counselor intends to accomplish in the next session or sessions.

Privileged Communication

• Fourth Amendment: guaranteed to all citizens; prohibits government searches without warrants. • Privacy right is not absolute. • Interest of society outweigh individual rights to privacy, privacy rights compromised in interest of preserving a stable societal structure. • *Basically means a judge cannot order information that has been recognized by law as privileged to be revealed in court. • Withholding evidence is antagonistic to entire system of justice. • Legal procedures demand all evidence relevant to a case be presented to a judge or jury. • Discovery: opposing side in a court case have access to evidence before a trial takes place. • As a counselor, you will want to guarantee that the information that clients give you will be kept confidential. • Idea that information and secrets revealed in a counseling session might someday be disclosed in court is very unsettling. How does this make you feel?

Contents of a Good Record

• Identifying data • Informed Consent/Treatment Plan • Diagnostic Testing and Assessment Interview • Background and Historical Data • Progress Notes • Current Psychological/Psychiatric Evaluations • Current Medications • Diagnosis • Consultations • Correspondence and Phone Calls • Suggestions/Directions • Failed or Canceled Appointments • Supervision • Prognosis • Release of Information • Termination Notes • Medicare Notes

Diversity Considerations

• In rural communities or small towns, one may find it impossible to avoid overlap among roles. • Other "small worlds" exist: military, deaf, gay, religious communities, political affiliations, ethnic identities, and substance dependency groups (many substance abuse counselors are in recovery themselves). • Pastoral counselors have overlapping relationships with members of their congregations and face unique boundary challenges.

Signs of Unhealthy Professional Boundaries

• Intimacy distortions • Falling in love with the client • Parentification of the client • Failure to notice that the counseling relationship is not a "real relationship" • Why is this not a real relationship?

Malpractice

• Involves professional misconduct or unreasonable lack of skill. • Defined as:"Failure of one rendering professional services to exercise that degree of skill and learning commonly applied under all the circumstances in the community by the average prudent reputable member of the profession with the result of injury, loss or damage to the recipient of those services or to those entitled to rely upon them. It is any professional misconduct, unreasonable lack of skill or fidelity in professional or fiduciary duties, evil practice, or illegal or immoral conduct (Black, 1990, p. 959). • Type of civil lawsuit that can be filed against professionals for practicing in a manner that leads to injury to a recipient of their services.

Record Keeping

• Is necessary but it is important that counselor's maintain BALANCE in order to provide quality counseling services to clients. • If spending excessive time on record keeping, need to reevaluate how you are spending your professional time and energy. • Not appropriate to neglect your counseling services to clients in order to produce excessive amounts of notes which are self-protective. • It is possible to keep adequate counseling records and provide quality counseling services.

Diversity Considerations

• Maintain sensitivity to the cultural meanings of privacy and confidentiality. • Some clients from some cultures, such as those who are collectivist in nature, may ot want their confidentiality upheld in the traditional manner. • Counselors is such cases, might share confidential information with family members or members of the client's community, if the client so desires.

Counselor Practices and Confidentiality

• Mental health professionals take seriously their pledge to maintain their clients' confidentiality and are diligent in honoring it (Grabois, 1997/1998). • New technology may present a problem to counselors. • Faxes, email, and cellular phones are not secure means of communication and confidential information should not be exchanged using these systems. • Do not obtain a colleagues advice while walking down the halls of an institution, or at a restaurant over lunch, or in other public places. • Students in training programs should exercise caution in maintaining client confidentiality. • The ethical obligations of students are the same as those of practicing counselors (Standard F. 8.a). • Do not leave case notes, audiotapes, videotapes of work with clients where they might be seen by anyone unauthorized to see them.

Counseling Minor or Legally Incompetent Clients

• Minors and adults who have been adjudicated incompetent in a court of law do not have a legal right to enter into contracts. • Parents or guardians control their legal rights. • Counselors owe legal duties to the parents or guardians of minors or incompetent adults. • At the same time, counselors have ethical obligations to the clients themselves (Standard B. 5).

Competence

• Not easy concept to define. • "involves a combination of knowledge, skills, and diligence" (Welfel, 2006). • Core areas of: o Professional identity; social and cultural diversity; human growth and development; career development; helping relationships; group work; assessment; and research and program evaluation (CACREP, 2001). Competence as an Ethical and Legal Concept Skilled counselors: • Able to select and use appropriate range of basic interviewing techniques, and therapeutic interventions. • Skill building starts in graduate school using applied courses: counseling skills and techniques, group work, practicum and internship. • Skills honed and expanded through postgraduate supervised counseling experience.

Inadequate Boundaries:

• Not noticing boundary invasions • Over-responsible for the client • Over-involvement with the client • Over-identification with the client • Role-confusion/Role reversal • Inappropriate self-disclosure • Inappropriate touch • Being manipulated by client's unreasonable demands • Responding to inappropriate personal questions • Acting on sexual attraction

Ethical Standards and Confidentiality

• Only specific ethical issue to which an entire section of the ACA Code of Ethics (2005) is devoted. • "Counselors recognize that trust is a cornerstone of the counseling relationship." (Intro to Standard B). • When client requests information be disclosed, counselor should honor their requests. • If counselor believes release of material would be detrimental to clients best interest, this should be discussed with the client. Ultimate decision belongs to the client. Confidentiality belongs to the client. • Records are kept for the benefit of the client, and counselors are obligated to provide clients with access to their records, unless the records contain information that may be misleading or harmful to the client (Standard B.6.d). HIPAA, federal statue, requires clients be given access to their counseling records. • Confidentiality is not absolute. Times when confidentiality must be breached. Counselors must inform clients at the outset that there are limitations to their confidentiality.

Problematic Nature of Dual Relationships Four characteristics:

• Potential dual relationship can be difficult to recognize. • Potential for harm ranges along a wide continuum from extremely harmful to benign or even beneficial. • With exception of sexual dual relationships, there is very little consensus among mental health professionals regarding the propriety of dual relationships. • Some dual relationships are unavoidable.

Sexual Dual Relationships

• Prohibition against sexual intimacies with help seekers is one of the oldest ethical mandates in the health care professions, preceding even the Hippocratic oath. • Frequencies vary according to self-report; • 7% of male counselors, 1.6% of female counselors report sexual relationships with their current or former clients. • Survey by Pope of patients, 20% reported having sexual contact with their counselors.

Informed consent, obtain permission before taping any sessions.

• Provide clients with access to records, or portions of records, unless they might be detrimental to clients. • Obtain permission from clients do disclose or transfer records to third party unless such exceptions exist. • Cover page that explains confidential nature of the records with statement explaining confidentiality of records and that they are not to be transferred to any third party. • Storage and disposal of records according to state guidelines. • Clarify nature of what will be disclosed to insurance companies before signing contract with health insurance company.

Guidelines

• Sexual attraction is real and it's like fire - play with it and you will get burned. Avoid denial of the issue or your invulnerability to its effects. Be aware of sexual fantasy and its dangers in the therapeutic setting. • Sexual suggestions initiated by the client in therapy can produce the greatest potential for counter transference. Counselors must learn to recognize the warning signs and address it as soon as possible. If necessary, discuss the situation with a colleague and/or make an appropriate referral of your client to another professional Maintain clear and consistent boundaries with all clients. Be aware and sensitive of touch, even therapeutic touch. Be careful of being alone in an office with a client when no other colleagues are around, especially someone of the opposite sex. Consider having co-facilitators when leading group therapy. Learn to challenge yourself and question your motives in situations that any objective person may view as a dual relationship. Seek out accountability relationships with other colleagues and commit to honest communication when having a struggle. Consider personal therapy if need be.

*SOAP:

• Subjective: information reported by client • Objective: results of counselor tests, assessments administered. • Assessment: Impressions generated by data. • Plans: diagnosis and treatment plan and modifications to them

Responding to Subpoenas

• Subpoena: legal document that might require a counselor to give a written response to a written list of questions, produce copies of records, appear for a deposition, court hearing, or trial; or appear and bring records with them. • If not responded to appropriately counselor can be held in contempt of court and fined or jailed until they comply. • Legal advice should be obtained before responding to a subpoena. • Attorneys could ask attorney to withdraw it, file a motion to quash the subpoena, or advise you to comply with the subpoena. • Follow attorneys advice. • Appearing at trial or deposition: ask attorney to prepare you for what to expect and advise you how to conduct yourself. • Have attorney go with you so you can be given advice throughout the whole proceeding. • Especially important to have attorney present during depositions, because a judge will not be present • *legitamite Subpoena comes from a judge