ethics chapter 7, ethics chapter 6, Ethics chapter 5, Ethics chapter 4, ethics chapter 3, Ethics chapter 2, Ethics chapter 1

_________, which is rooted in a client's right to privacy, is at the core of effective therapy; it "is the counselor's ethical duty to protect private client communication"

Confidentiality

Among the conditions that warrant disclosure of information shared in the counseling relationship are these legally mandated exceptions to confidentiality and privileged communication:

Disclosure of confidential information is ordered by a court Client waiver of the privilege Clients file complaints and litigation against their counselors Clients claim psychological damage in a lawsuit Civil commitment proceedings are initiated Statutes involving child abuse or elder abuse mandate disclosure Clients pose a danger to others or to themselves

When in the therapy process is the offering of a gift occurring? When is the best time accept a gift?

It could be more problematic to accept a gift at an early stage of a counseling relationship because doing so may be a forerunner to creating lax boundaries. A gift at the end of therapy may have cultural and symbolic value for clients.

__________ also include providing therapy to a relative or a friend's relative, socializing with clients, becoming emotionally or sexually involved with a client or former client, combining the roles of supervisor and therapist, having a business relationship with a client, borrowing money from a client, or loaning money to a client.

Multiple relationships

__________ occur when professionals assume two or more roles at the same time or sequentially with a client. This may involve assuming more than one professional role (such as instructor and therapist) or blending a professional and a nonprofessional relationship (such as counselor and friend or counselor and business partner)

Multiple relationships

practitioners in small communities can minimize risk and practice ethically and professionally by following these steps:

Obtain informed consent Document thoroughly Set clear boundaries and expectations, both for yourself and with your clients Pay attention to matters of confidentiality Get involved in ongoing consultation or a peer supervision group

Fisher (2008, 2016) has designed a six-step ethical practice model for protect- ing confidentiality rights that places legal mandates in an ethical context. The six steps include the following:

Preparation Tell clients the truth. Obtain "truly informed consent" before disclosing voluntarily. Respond ethically to legal demands for information. Avoid preventable breaches of confidentiality. Talk about confidentiality.

____________ is the most potentially damaging boundary violation.

Therapist- client sexual contact

Zur and Nordmarken identify the following ethical and clinical guidelines for nonsexual touch in therapy:

Touch should be employed only when it is likely to have a positive therapeutic effect. Touch should be used in accordance with the therapist's training and competence. It is essential that therapists create a foundation of client safety and empowerment before using touch. In deciding to touch, it is important to thoughtfully consider the client's potential perception and interpretation of touch. Special care is important in using touch with people who have experienced assault, neglect, attachment difficulties, rape, molestation, sexual addictions, or intimacy issues. It is the responsibility of therapists to explore their personal issues regarding touch and to seek education and consultation regarding the appropriate use of touch in therapy. Therapists should not avoid touch out of fear of licensing boards or the dread of litigation. Clinically appropriate touch must be used with sensitivity to clients' variables such as gender, culture, problems, situation, history, and diagnosis.

Certain behaviors of professionals have the potential for creating a multiple relationship, but they are not inherently considered to be multiple relationships. Examples of these behaviors include

accepting a client's invitation to a special event such as a graduation; bartering goods or services for professional services; accepting a small gift from a client; attending the same social, cultural, or religious activities as a client; or giving a supportive hug after a difficult session

Practitioners should exercise caution with regard to the privacy of their clients. It is easy to invade a client's privacy unintentionally. Examples of some of the most pressing situations in which privacy is an issue include

an employer's access to an applicant's or an employee's psychological tests, parents' access to their child's school and health records, and a third-party payer's access to information about a client's diagnosis and prognosis.

A good policy is to limit email and text message exchanges to basic information such as an ___________

appointment time.

In some cultures, and especially in rural communities,___________ is an accepted practice and frequently conforms to prevailing community standards

bartering

When a client is unable to afford therapy, it is possible that he or she may offer a____________arrangement, exchanging goods or services in lieu of a fee. For example, a mechanic might exchange work on a therapist's car for counseling sessions.

bartering

___________ is a legitimate means of making psychological services available to people of limited economic means

bartering

____________ arrangements with clients can be both a reasonable and a humanitarian practice when people require psychological services but do not have insurance coverage and are in financial difficulty.

bartering

A ____________ is a departure from commonly accepted practices that could potentially benefit clients; a __________ is a serious breach that results in harm to clients and is therefore unethical

boundary crossing boundary violation

engaging in ____________ paves the way to boundary violations and to becoming entangled in complex multiple relationships.

boundary crossings

If a therapist's actions result in harm to a client, it is a__________

boundary violation.

inappropriately expensive gifts or any gifts that create indebtedness, whether of the client or the therapist, are ____________

boundary violations.

reasons social relationships with clients might be a good thing

building trust and rapport honoring cultural values and needs - cultural values on multiple relationships with helping professionals - beliefs that personal matters should be discussed with only friends/relatives - engagement in important events, experiences, and rituals - advocacy efforts, professional memberships - breaking down barriers of historical mistreatment through self-disclosure/connection

Those with relatively little ___________ might be well advised to avoid engaging in multiple relationships whenever possible.

clinical experience

Professionals must not disclose this information except when authorized by law or by the client to do so. Hence, there are limitations to the promise of __________

confidentiality.

If a client gives her therapist a small painting she created as a token of gratitude and her therapist declines the gift, the client may feel rejected because she personally created the gift. this is an example of when ......

crossing a boundary is okay

boundary __________ (changes in role) and boundary __________ (exploitation of the client at some level)

crossings violations

what effects does sexual relationships with clients all have on the profession of counseling as a whole?

damaged reputation/ credibility public and client trust negative publicity (on top of already existing stigma)

Professionals get into trouble when their boundaries are poorly ___________ and when they attempt to blend roles that do not________

defined mix (such as professional and social roles).

there are virtually no circumstances in which it is appropriate for a therapist to initiate a _____ with a patient,

hug

Offering therapy where? Can aid in building a therapeutic relationship and provides the clinician with the opportunity to observe the client's experience firsthand.

in a client's home

Despite the benefits of outreach psychotherapy, graduate programs continue to emphasize_________ training and are not adequately preparing students for the challenges encountered when meeting clients in their homes or working in the community.

in-clinic

Perhaps out of a fear of experiencing sexual attraction to clients, or even worse, the temptation to engage in sexual misconduct, some clinicians address the issue proactively by broaching the topic during the ______________

informed consent discussion at the initial session.

what harms can come to the client die to sexual misconduct of a therapist?

isolation; fear trust issues depression; anxiety; anger shame, guilt, embarrassment suicidal tendencies; substance misuse post traumatic stress damaged interpersonal and romantic relationships

It is critical to disclose the limits of confidentiality with clients if wireless telephones are used; Brenes and colleagues recommend _________ to ensure greater privacy and confidentiality for clients.

land lines

what negative consequences of sexual relationships with clients occur for the clinican?

lawsuit/ personal liability felony convictions license revoked or suspended expulsion from professional organizations loss of insurance coverage loss of professional standing and ability to get a job reputation in the field with colleagues and other practitioners

_________ mental health providers must increase their tolerance for routine boundary crossings and contacts with clients outside the consulting room

military

in ________ settings multiple relationships are common and can be a healthy part of communal life. These relationships can improve morale, decrease the stigma attached to seeking psychological assistance, and improve access to care

military

The APA (2010) ethics code defines a _________. as one in which 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.

multiple relationship

Professionals are obligated to disclose information that is __________ when the client requests it, but only the information that is specifically requested and only to the individuals or agencies that are specified by the client.

necessary and sufficient

Telephone, answering machine, voice mail, fax, cellular phone, text messaging, and email all pose a number of potential ethical problems with regard to protecting client _______

privacy.

_________ belongs to the client and is designed for the client's protection rather than for the protection of the counseling professional.

privileged communication

which laws ensure that personal and sensitive client information will be protected from exposure by therapists in legal proceedings.

privileged communication

reasons social relationships with clients might be a bad thing

problematic/unmanaged transference and countertransference issues - may not be as challenging; need to be liked and accepted by the client counselors own needs may be enmeshed with client's, damaging objectivity counselors are at greater risk of exploiting clients because of the power differential

why might a counselor accept of give a gift?

promotes the client's welfare does not compromise counselor's objectivity ot competence consistent with client's cultural norms small monetary value rare event, not a recurrent practice

what types of boundaries are there?

psychological boundaries emotional boundaries physical boundaries

A rigid ___________ application of boundaries can be harmful to clients by creating a sterile relationship that works against establishing a positive therapeutic alliance. Examples of such rigidity include never touching a client under any circumstances, refusing every small gift, or refusing to extend a session for any reason

risk-avoidance

The task of managing boundaries is more challenging in ________ areas, and practitioners often are called upon to examine what is in the best interests of their client.

rural

Practitioners in_________communities experience greater visibility than those in ________ settings, which has a bearing on the way therapists take care of themselves and how they balance their personal and professional life

rural urban

A common type of boundary crossing is therapist __________

self-disclosure.

Gutheil and Gabbard (1993) and Gabbard (1994) cite the ____________ as one of the strongest arguments for carefully monitoring boundaries in psychotherapy. Once a practitioner crosses a boundary, the tendency to engage in a series of increasingly serious boundary violations can lead to a progressive deterioration of ethical behavior

slippery slope phenomenon

If emails are sent directly to your __________, the risks to privacy and confidentiality increase.

smartphone

Speight proposes the concept of __________, rooted in the ties within a society that bind people together, as a culturally congruent way of understanding, defining, and managing boundaries

solidarity

what are boundaries?

something that indicates bounds or limits; a fixed limit or bounding line

The tendency to treat sexual feelings as if they are _______ has made it difficult for therapists to acknowledge and accept attractions to clients

taboo

Compared to other forms of electronic technology, Brenes, Ingram, and Danhauer (2011) suggest the _________ may be the preferred method for providing psychological services.

telephone

counselors consider forming multiple relationships only when it is clear that such relationships are in the best interests of ________

the client.

considerations of having nonsexual social relationships with current or former clients

the counselor must honor promises made to clients - to act in good faith and loyalty toward a client - to not abuse power imbalance by exploiting client - act in the best interest of client the client is emotionally vulnerable - compromised by client disclosure - confusing boundaries - obstacles in working through transference the counselor has more power than the client - clients autonomy is compromised - counselor less "professional" - confidentiality is challenged

physical boundaries

the space around you, including physical touch; you have the right to ask people not to get too close to you

School counselors need to balance their ethical and legal responsibilities with three groups:

the students they serve, the parents or guardians of those students, the school system.

Practitioners who have difficulty establishing clear boundaries in _____________________are more likely to encounter problems defining appropriate boundaries with their clients.

their personal life

Clinically appropriate ________ can increase a client's trust and ease with the therapist and can be effective in enhancing the therapeutic alliance.

touch

___________ in therapy is not inherently unethical and that none of the codes of ethics of professional organizations view touch as unethical.

touch

a _________ given at the right moment can convey far more empathy than words can.

touch

If _____________occurs, it should be a spontaneous, nonsexual, and honest expression of the therapist's feelings and always done for the client's benefit. It should not be done as a technique.

touching

In an addiction treatment center, the policy may be "what is said to one staff member is said to all." One reason for this practice may be to avoid __________ of the staff, which would be detrimental to patients

triangulation

t/f Although bartering is not prohibited by ethics or law, most legal experts frown on the practice

true

t/f Although forming friendships with former clients may not be unethical or illegal, the practice can lead to problems. The safest policy is probably to avoid developing social relationships with former clients.

true

t/f Even if clients behave in seductive ways, it is clearly the professional's responsibility to establish and maintain appropriate boundaries. To blame the client in these cases is as inappropriate as blaming a victim in a rape case.

true

t/f If the multiple relationship is judged to be appropriate and acceptable, the therapist should document the entire process, including having the client sign an informed consent form

true

t/f If therapists have had a prior sexual relationship with a person, many of the ethics codes also specify that they are prohibited from accepting this person as a client.

true

t/f In some circumstances, the therapist can make a clinical decision to withhold all or some information if the client waves his or her privilege. For example, if the therapist believes the client is not mentally competent to make such a decision, the therapist may not abide by the client's request to waive privilege.

true

t/f Most of the organizations state that in the exceptional circumstance of sexual relationships with former clients— even after a 2- to 5-year interval—the burden of demonstrating that there has been no exploitation clearly rests with the therapist

true

t/f The legal concept of privileged communication generally does not apply to group counseling, couples counseling, family therapy, or child and adolescent therapy.

true

t/f There are advantages to crossing boundaries in certain circumstances

true

t/f When it does become necessary to break confidentiality, it is good practice to inform the client of the intention to take this action and also to invite the client to participate in the process.

true

t/f appropriate gift-giving can be a healthy aspect of a therapist-client relationship and can enhance therapeutic effectiveness.

true

t/f bartering is a healthy norm in many cultures.

true

t/f crossing boundaries may be clinically relevant and appropriate in some cases, and that avoiding crossing some boundaries could work against the goals of the therapeutic relationship

true

t/f it may be difficult for clinicians to readily discern the difference between a positive boundary crossing and a boundary violation.

true

t/f practicing risk management by rigidly avoiding touch may be unethical.

true

t/f practitioners agree that rejecting appropriate gifts of small monetary value but of high relational value can be offensive to clients and negatively affect the therapeutic alliance

true

t/f the focus of mentoring is always on the mentee's personal and professional development.

true

t/f Confidentiality belongs to the client, and counselors generally do not find it problematic to release information when the client requests that they do so.

true

t/f If a client knowingly and rationally waives this privileged communication, the professional has no legal grounds for withholding the information

true

emotional boundaries

whether (or how much) you let other people affect you emotionally, including whether you let other people manipulate your emotions (ex. making you feel happy or guilty)

psychological boundaries

whether or not you share information about yourself, opinions, thoughts and beliefs you have

Although the codes of ethics of most professions caution against engaging in nonsexual multiple relationships, they are not necessarily problematic, and some are beneficial. For example, ____________ involves blending roles, yet both mentors and learners can certainly benefit from this relationship.

"mentoring"

APA code of ethics Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to

(1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose.

Sperry and Pies (2010) discuss the ethical considerations in writing about clients. They identify three options for presenting case material:

(1) seek the client's permission to publish, which some consider ethically questionable because it entails inserting the clinician's professional agenda into the client's treatment; (2) disguise case material for publication, which may or may not release the therapist from needing to secure the client's permission; or (3) develop composite case material from two or more clients.

Here are some reasons for discouraging the practice of accepting friends as clients or of becoming socially involved with clients:

(1) therapists may not be as challenging as they need to be with clients they know socially because of a need to be liked and accepted by the client; (2) counselors' own needs may be enmeshed with those of their clients to the point that objectivity is lost; (3) counselors are at greater risk of exploiting clients because of the power differential in the therapeutic relationship.

when bartering, Woody states that you will have the burden of proof to demonstrate that .......

(a) the bartering arrangement is in the best interests of your client; (b) is reasonable, equitable, and undertaken without undue influence; (c) does not get in the way of providing quality psychological services to your client.

___________ is an example of a practice that we think allows some room for therapists, in collaboration with their clients, to use good judgment and consider the cultural context in the situation.

Bartering

__________ or __________ increase the possibility that therapists may misuse their power to influence and exploit clients for their own benefit and to the clients' detriment

Boundary crossings or multiple relationships

Here are a few guidelines for bartering arrangements:

Determine the value of the goods or services in a collaborative fashion with the client at the outset of the bartering arrangement. Estimate the length of time for the barter arrangement. Document the bartering arrangement, including the value of the goods or services and a date on which the arrangement will end.

__________, as a matter of law, refers to the constitutional right of individuals to be left alone and to control their personal information. _______ is the right to be protected from visibility, access, or intrusion by others

Privacy

____________ is a legal concept that generally bars the disclosure of confidential communications made to a psychotherapist from any judicial proceedings or court of law

Privileged communication

__________ is not necessarily unethical, but it does call for vigilance on the part of the professional to ensure that exploitation does not occur.

Role blending

__________, or combining roles and responsibilities, is quite common in some professions. For example, counselor educators serve as instructors, but they sometimes act as therapeutic agents for their students' personal development.

Role blending

________ counseling is anything but the neat-and-tidy model in which a practitioner sees each individual client one hour per week in a single office

Rural

____________ is considered to be one of the more serious of all ethical violations for a therapist, and it is also one of the most common allegations in malpractice suits

Sexual misconduct

consider these exceptional circumstances in which it is permissible to share information with others in the interest of providing competent services to clients:

When the client requests a release of information When reimbursement or other legal rules require disclosure When clerical assistants handle confidential information, as in managed care When the counselor consults with experts or peers When the counselor is working under supervision When other mental health professionals request information and the client has given consent to share When other professionals are involved in a treatment team and coordinate care of a client