590 Unit 2 – Flashcards

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Confidentiality
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*It is the counselor's ethical duty to protect private client information *Confidentiality is at the core of effective therapy
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Privileged Communication
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*A legal concept. The right of a client to not have their disclosures talked about in the legal proceedings. *Specifics of this privilege vary from state to state.
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Privacy
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The constitutional right of individuals to be left alone and to control their personal information.
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Fisher's (2008) 6-step ethical practice model for protecting confidentiality rights
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*Preparation: Know before entering a counseling relationship what you're going to do *Tell clients the truth up front (let them know when you're able to tell their information to other people) *Obtain truly informed consent before making a disclosure *Respond ethically to legal requests for disclosure (Only give what is needed/required) *Avoid the "avoidable" breaches of confidentiality (Take all possible measures to avoid confidentiality breaches) *Talk about confidentiality (Talk about it often with your clients. Renew your informed consent agreements with clients at least once a year)
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Limits of Confidentiality (when it can be breached)
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•When clerical assistants handle confidential information •When a counselor consults (Only give them relevant information and nothing else) •When a counselor is being supervised (Tell the clients that you are under supervision and give them the supervisor's contact information) •When a client has given consent (When they say it's okay for you to share their information) •When a client poses danger to self or others (State laws differ on this) •When a client discloses intention to commit a crime (In most instances, you are not mandated to tell the authorities about this, but you may. Only mandated if someone is going to get hurt) •When a counselor suspects abuses or neglect of a child or elderly/dependent adult (If you have reasonable suspicion; proof is not necessary) •When a court orders counselors to make records available (You can say no to a subpoena and nothing happens; if you say no to a court order, you might go to jail)
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Privacy Issues with Telecommunication Devices
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•Do not acknowledge that clients are receiving services or give out information regarding clients to unknown callers (In case it is another person on the line) •Strive to verify that you are actually talking to the intended person when you make or receive calls in which confidential information will be discussed (Maybe use a code word, or a password, or question they must answer to verify that it's actually them) •Be aware that there is no way to prevent your conversation from being recorded or monitored by an unintended person •Avoid making any comments you would not want your client to hear or you would not want to repeat in a legal proceeding (Only say what's relevant to the topic at hand. Once something is heard by a third-party (voicemail, etc.), it is no longer protected/privileged information) •Be professional and cautious in talking about confidential information over the telephone •Avoid saying anything off the record. NOTHING IS OFF THE RECORD. •Do not allow unauthorized persons to hear answering machine messages in your office as they are being left or received. •If you are talking to a client by cellular phone, assume that he or she is not in a private place: (you never know where people are or who is there) •Realize that your conversation may be intercepted by an unauthorized person •If you use voicemail or an answering service, ensure your access codes are not disclosed to unauthorized persons •If you use a pager or cell phone to send text messages, exercise caution *In sending a text message to a client, be mindful of ensuring your client's privacy by exercising the same caution you would if you were sending a voicemail message •When you leave a message on an answering machine, be aware that the intended person may not be the one who retrieves your message.
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HIPAA
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•The Health Insurance Portability and Accountability Act of 1996 *Promote standardization and efficiency in the health care industry and give patients more rights/control over their health information.
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Implications of HIPAA for Mental Health Providers
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•If you submit a claim electronically, even once, you are likely to be considered a "covered entity" for HIPAA purposes. •Know that WE ARE SUBJECT TO IT. We are tasked with keeping our client's information private and updating the forms on a yearly basis.
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4 Standards of HIPAA
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•Privacy requirements *Electronic transactions (fax) *Security requirements (rules how records are secured) *National identifier requirements
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HIPAA Privacy Rule
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*A bill that was introduced originally to standardize medical records. Now it's our responsibility to keep our clients safe and private. Primarily applies to records that are electronically transmitted. •Applies to any practitioner who uses records electronically.
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Duty to Protect Potential Victims •Counselors must exercise the ordinary skill and care of a reasonable professional to:
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*Identify clients who are likely to do physical harm to third parties *Protect third parties from clients judged potentially to be dangerous *Treat those clients who are dangerous •Balancing client confidentiality and protecting the public is a major ethical challenge.
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Liability for Civil Damages •The responsibility to protect the public from dangerous acts of violent clients entails liability for civil damages when practitioners neglect this duty by:
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*Failing to diagnose or prevent dangerousness *Failing to warn potential victims of violent behavior *Failing to commit dangerous individuals (has to be very noticeable) *Prematurely discharging dangerous clients from a hospital
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Legal Precedents (court cases)
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•Tarasoff Case: Duty to warn of harm to self or others; Duty to protect •Hedlund Case: Extends duty to warn to anyone who might be near the intended victim and who might also be in danger
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In cases involving the duty to warn and protect, what should a counselor do?
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•Consult with an attorney if you are not clear about your legal duty as well as with colleagues or a supervisor. •Know the relevant laws in your state. •Inquire about a client's access to weapons, homicidal ideation, and intentions, including whether a specific victim is involved. *Find out the access the client has to the means they plan to do (do they really have intent to go through with their malicious thought, and a plan to see this through) *Know specifically who might be in danger •Consider all appropriate steps to take and their consequences •Obtain prior medical behavioral history •Know and follow the policies for where you work •If there's an immediate threat by the client, don't hesitate to take steps to ensure your safety •Document all actions you take and the rationale behind those decisions •Make referrals when appropriate
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School Counselor Liability for Student Suicide
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•Counselors need to educate school employees (especially teachers) about the risk factors associated with adolescent suicide •Counselors might institute peer assistance programs to help identify students at risk for suicide •It would be useful for school counselors to have increased access to training programs geared toward acquiring information about student suicide •In cases where school counselors make an assessment that a student is at risk for suicide, it is imperative that the student's parents or guardians are notified •One of the first cases that addressed school counselor liability for student suicide was Eisel v. Board of Education (1991). •School counselors would do well to take the initiative in obtaining continuing education on recent developments in the field of student suicide to help limit their legal liability.
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Guidelines for Assessing Suicidal Behavior
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•Take direct verbal warnings seriously •Pay attention to previous suicide attempts •Identify clients suffering from depression •Be alert for feelings of hopelessness and helplessness •Monitor severe anxiety or panic attacks •Explore the interpersonal stressor of loss and separation •Ascertain whether there has been a recent diagnosis of a serious or terminal health condition •Ascertain whether there has been any suicide in the family •Assess the client's support system *If there is no support system, the client is at greater risk •Determine whether the client has a plan •Identify clients who have a history of severe alcohol or drug abuse •Be alert to client behaviors (giving away prized behaviors, taking care of final business, etc.) •Determine the history of psychiatric treatment
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Protecting Children, Elderly, and Dependent Adults from Harm
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•If children, the elderly, or other dependent adults disclose that they are being abused or neglected, the professional is required to report the situation under penalty of fines and imprisonment.
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Types of Elder Abuse
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• Physical abuse • Sexual abuse • Psychological or emotional abuse • Neglect • Abandonment • Financial or material exploitation
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Disclosure of a Client's HIV Status
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•The law is not clear pertaining to the duty to protect in cases pertaining to HIV status •It is extremely important to know the specific law in your jurisdiction and to seek consultation from a colleague experienced with reporting requirements •From a legal perspective, breaching confidentiality because of a client's HIV status is not one of the exceptions to confidentiality
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Recommendations for Counseling HIV-Positive Clients
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•All limits to confidentiality should be discussed at the outset of treatment •Therapists must be aware of state laws regarding their professional interactions with HIV-positive clients. •Therapists need to keep current with relevant medical information, including which sexual practices are safer. •Therapists should speak directly and openly with their clients about their concerns regarding the danger of certain behaviors and the risk to third parties. •If the client continues to resist using safer sex practices or refuses to inform partners, then the therapist needs to determine what course of action to follow. •In disclosing HIV information, therapists need to follow the statutory guidelines and safeguard the client's privacy as much as possible. •Understand what it means to be HIV-Positive and how people can be put at risk •Just because someone gives you permission to disclose, be careful to only make public what is absolutely necessary and inform your clients about this also. Breaking confidentiality happens far too often because people don't think about the repercussions
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Multiple Relationships
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•Any time you have a professional relationship with someone and you also have some other type of relationship with them. *These used to be prohibited, now it is accepted as long as it is not unethical.
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Viewpoints on Multiple Relationships
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•The rationale for abstaining from multiple relationships involves the potential for therapists to misuse for their own benefit and to the clients' detriment *Can't be objective if you're in a close relationship with someone and there is the potential of exploiting clients by misusing the power you have *Many multiple relationships can be ethical and okay though
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Boundary Crossings vs Boundary Violations
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•Boundary Crossing: A departure from commonly accepted practices that could potentially benefit clients *Departing from typical practice boundaries in an effort to benefit the client •Boundary Violation: A serious breach that results in harm to clients and is therefore unethical *When you go too far (sexual exploitation, going out to dinner with a client, etc.)
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How to minimize the risks of boundary violations
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*Set healthy boundaries from the outset *Secure informed consent of clients *Discuss both potential risks and benefits *Consult with other professionals to resolve any dilemmas *Seek supervision when needed *Document in clinical case notes -If it sounds inappropriate while writing, it might be an unethical relationship -Converse and document if you have a conversation about the possible conflicts from this multiple relationship *Examine your own motivations -If something could go wrong with the relationship, DON'T DO IT -A lot of times the biggest issue is public perception (buying cookies from a client's kid) *Refer when necessary
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Complications of Managing Multiple Relationships in a Small Community
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•Practitioners who work in small communities often have to blend several professional roles and functions *Rural community is about 5000 people •They have to become an integral part of the community to be accepted as a credible mental health resource •If these practitioners isolate themselves from the surrounding community, they are likely to alienate potential clients and this reduce their effectiveness in the settings where they work
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Prior to Establishing a Bartering Relationship, what should you do?
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•Evaluate whether it puts you at risk of impaired professional judgement •Determine the value of goods or services in a collaborative fashion *Make sure it is a fair value swap (fair doesn't mean equal!) •Determine appropriate length of time for arrangement •Document arrangement and consult with experienced colleagues or supervisors *Why document? Removes the possibility of exploitation
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Bartering (what is the best way to do it?
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•Have guidelines to clarity barter arrangements •Exchanging goods for services is optimal *Minimize unique financial arrangements *Both therapist and client should have a written agreement for the compensation by bartering *If a misunderstanding develops, the matter should be dealt with by a mediators, not by you and your client
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When deciding whether or not to accept a gift from a client, ask yourself:
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*What is the monetary value of the gift? *Sentimental value? *What are the clinical implications of accepting or rejecting the gift? *Consider the client's motivations for giving you a gift (gratitude, genuine niceness, just their hobby, etc.) *When in the therapy process is the offering of a gift occurring? Towards the end is likely less problematic *What are my motivations for accepting or rejecting a gift? *What are the cultural implications of offering a gift?
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Disadvantages of Socializing with Clients
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•Therapists may not challenge clients they know socially because of a need to be liked and accepted by the client *Might be less inclined to pressure or push them because of this •Counselors' own needs may be enmeshed with those of their clients to the point that objectivity is lost •Counselors are at greater risk of exploiting clients because of the power differential in the therapeutic relationship •Former clients may need you more as a therapist at some future time than as a friend
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Lazarus's Thoughts on Socializing with Clients
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•Lazarus believes he does a lot of good with his clients unconditionally out of the office (example: playing tennis with his clients). Believed strongly in multiple relationships
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Sexual Attractions in Therapy
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•Simply experiencing sexual attraction to a client, without acting on it, makes the majority of therapists feel guilty, anxious, and confused •Neglecting to attend to family-of-origin issues can lead to blind spots such as being attracted to clients *Make sure you have worked through your own issues while in training so they don't pop up during a counseling session
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To minimize the likelihood of sexual transgressions:
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*Learn to recognize sexual attractions and how to deal with these feelings constructively and therapeutically *Seek professional support during times of loss or crisis *Establish and maintain clear boundaries when a client makes sexual advances toward you. *Terminate the therapeutic relationship when sexual feelings obscure objectivity. *Recognize that direct explicit disclosures of sexual feelings can run the risk of harming clients and may therefore be unethical. *Rather than making any explicit communication of sexual feelings for clients, acknowledge caring and warmth within the therapeutic relationship. *Practice a risk management approach (e.g., be aware of timing and the location of scheduled appointments, non-erotic touch, and general self-disclosure).
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A counselor should be open to ___, ___, and ___ throughout their career
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Supervision, consultation, and personal therapy
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Clients who are the victims of sexual misconduct suffer these dire consequences:
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*Distrust of the opposite sex *Distrust of therapists and the therapeutic process *Guilt, depression, anger, and/or PTSD *Feeling of rejection and low self-esteem *Suicidal ideation
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Negative consequences for therapists who engage in sexual misconduct include:
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*Being the target of a lawsuit *Being convicted of a felony *Having license revoked or suspended by state *Being expelled from professional organizations *Losing their insurance coverage *Losing their jobs
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Counselors practice only within the boundaries of competence, based on:
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*Education *Training *Supervised experience *State and national professional credentials *Appropriate professional experience
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Assessment of Competence (F+S)
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•Assessment approaches are most effective when they integrate both formative and summative evaluations. •Formative assessment is a developmentally informed process that provides useful feedback during one's training and throughout one's professional career. •Summative assessment is an end point evaluation typically completed at the end of a professional program or when applying for licensure status.
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How can Counselors Develop or Upgrade Their Skills?
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•Work with colleagues or professionals who have more experience. •Seek consultation before moving outside areas in which you have received education and training. •Learn new skills by attending conferences, reading professional articles, taking courses, and participating in workshops.
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When to make a referral?
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•You may need to refer a client if the resources are limited in the setting in which you work. *You may also need to refer a client if the boundaries of your professional role restrict you from delivering the services your client needs. •Consider a referral as a final intervention after you have exhausted other interventions including consulting.
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Therapist training programs have an ethical responsibility to:
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*Establish clear selection criteria *Provide exposure to major contemporary counseling theories *Teach students strengths and limitations of theories *Combine academic and personal learning *Screen candidates to protect public from incompetent practitioners *Teach a range of skills to work with diverse clients *Provide training in ethics
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Evaluating Character and Psychological Fitness of Trainees
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•Character fitness: The honesty and integrity with which a person deals with others •Psychological fitness: The emotional or mental stability necessary to practice safely and effectively. Evidenced by the presence of personality adjustment, absence of psychological disorder, and appropriate use of substances *Interpersonal behaviors of trainees have a direct bearing on their clinical effectiveness, so these factors must be taken into consideration in the evaluation process.
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Gatekeeper Role of Faculty in Promoting Competence
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•The academic faculty in a professional program protects consumers by identifying and intervening with graduate students who exhibit problematic behaviors. •Well-designed gatekeeping procedures improve the effectiveness with which deficient students are identified and prevented from progressing unremediated into the counseling profession. •Dismissal from a program is a measure of last resort.
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Certification
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*Voluntary attempt by a group to promote professional identity *Sets minimum standards *Does not assure quality practice
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Licensure
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*More serious than Certification *Governs professional practice *Highlights uniqueness of an occupation *Restricts both use of title and practice of occupation
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Four major goals of supervision:
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*To promote supervisee growth and development *To protect the welfare of the client *To monitor supervisee performance and to serve as a gatekeeper for the profession *To empower the supervisee to self-supervise and carry out these goals as an independent professional
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Informed Consent in Supervision
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•The standard of practice is to incorporate clear informed consent material for supervisees, both orally and in writing. •It is beneficial to discuss the rights of supervisees from the beginning of the supervisory relationship. •When supervisees learn what they can expect in supervision and what to do to achieve success, they are empowered to express expectations, make decisions, and become active participants in the supervisory process.
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The following topics should be included in a supervision contract:
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*Supervisor's background *Methods to be used in supervision *Responsibilities and requirements of supervisors *Supervisee's responsibilities *Policies pertaining to confidentiality and privacy *Documentation of supervision *Risks and benefits *Evaluation of job performance *Complaint procedures and due process *Professional development goals *Duration and termination of the supervision contract
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Rights of Supervisees
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•Supervisory sessions free from distractions •To be fully informed of supervisor's approach •Confidentiality with regard to supervisee's disclosure •Confidentiality with regard to clients except as mandated by law •Continual access to records maintained during supervision •To provide feedback to supervisors concerning supervision experience •To seek consultation from other professionals as necessary
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Responsibilities of Supervisees
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•Come prepared to each supervision session. •Be an active participant. •Do related research and reading between sessions to enhance your clinical work. •Pay attention to your interactions with clients and with your supervisor. •Be willing to address any areas of concern you have. •If you are having trouble with colleagues or fellow supervisees, bring such matters into supervision. •Ask for feedback about your strengths and areas where you need to improve and be open to feedback from supervisors, fellow supervisees, and your clients. •Establish healthy boundaries for yourself. •Let your supervisor know if you are feeling overwhelmed by your work with clients. •Be open to various forms of supervision, including live supervision and videotaping. •Talk about insecurities and anxieties you have that pertain to your work. •Provide feedback to your supervisor about what you find helpful or unhelpful in your supervisory relationship. •Pay attention to possible sources of countertransference *In supervision, explore how these reactions are affecting your work with clients.
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The Supervisor's Roles and Responsibilities
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•Supervisors must be competent both in the practice of supervision and in the area of counseling being supervised. •Supervisors should provide supervision only after obtaining the education and training to ensure competence in this role, and only if they can devote the time to provide adequate oversight. •Supervisors are ultimately responsible, both ethically and legally, for the actions of their trainees. •Supervisors have responsibilities to supervisees' current and future clients. •Supervisors must have a clearly developed framework for supervision and a rationale for the methods they employ. •The quality of the supervisory relationship is just as important as the methods a supervisor chooses. •A good portion of the supervisory sessions should focus on the personal stress experienced by the supervisee during client-counselor interactions.
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Methods of Supervision
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•Self-Report is widely used, yet it may be the least useful. *Procedure is limited by the supervisee's conceptual and observational ability. •Process Notes build on the self-report by adding a written record explaining the content of the session and the interactional processes. •Audio Recording is a widely used procedure that yields direct and useful information about the supervisee. •Video Recording allows for an assessment of the subtleties of the interaction between the supervisee and the client. •Live Supervision, which is conducted by the supervisor during the supervisee's session with a client, provides the most accurate information about the therapy session.
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How to Assess the Competence of Supervisors
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•LPCs who practice supervision are required to have relevant training experiences and course work in supervision.
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Good Supervisors demonstrate the four A's:
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*They tend to be available, accessible, affable, and able.
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Legal Aspects of Supervision
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•Informed consent •Confidentiality and its limits •Liability *Direct liability *Vicarious liability
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Direct+Vicarious Liability
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•Direct liability: If a supervisor tells a trainee to do something, the supervisor is directly liable •Vicarious liability: A supervisor is responsible for what a trainee does, even if they didn't know about the trainee's actions or their directions were opposed
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The following ethical issues have taken on added dimensions due to Online Supervision:
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*Confidentiality *Informed consent *The supervisory relationship •A major consideration is whether online supervision will count toward licensure when the supervisor and supervisee reside in different states.
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Risk Management Practices for Supervisors
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•Don't supervise beyond your competence. •Evaluate and monitor supervisees' competence. •Be available for supervision consistently. •Formulate a sound supervision contract. •Maintain written policies. •Document all supervisory activities. •Consult with appropriate professionals. •Maintain a working knowledge of ethics codes, legal statutes, and licensing regulations. •Use multiple methods of supervision. •Have a feedback and evaluation plan. •Verify that your professional liability insurance covers you for supervision. •Evaluate and screen all clients under your supervisee's care. •Establish a policy for ensuring confidentiality. •Incorporate informed consent in practice.
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Dimensions of a good multicultural model in supervision:
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*Pluralistic philosophy *Cultural knowledge *Consciousness raising *Experiential training *Contact with racial and ethnic minorities *Practicum or internship with culturally diverse populations
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Multiple Roles and Relationships in the Supervisory Process (two examples and issue with each)
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•Sexual intimacies during training: *Core issue is difference in power and status •Providing counseling for trainees: *Dual relationship standard of ethical conduct should be used
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Huge part of working with families is: (2)
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•Self-knowledge of your own family-of-origin and being able to separate how you were raised as a child or your family values from what your client thinks. •Think about how money is valued/handled, same with thoughts about sex; who has the power in the family *Their values are what's important, not yours.
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Differences in confidentiality between individual and family/group counseling
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•Privilege cannot be invoked if there are multiple people present
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What to know before performing family/group counseling
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*You need to have a policy as to how you're going to handle secrets. Some people have a no-secrets policy but some do not *You need training and practice because it is a difficult skill. Hard to juggle the personalities and dynamics that are present in the room
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The basic standard of care for school counselors is clear; courts have uniformly held that:
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•School personnel have a duty to protect students from foreseeable harm
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In ________, a Supreme Court decision ruled that communications between licensed psychotherapists and their clients are privileged and therefore protected from forced disclosure in cases arising under federal law
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•Jaffee v. Redmond
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In the case of disclosing confidential information when working with an HIV-positive client, several writers state that the therapist has a duty to protect when the following condition exists:
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•Clear and imminent danger must exist
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Even if clients argue that they can do what they want with their own lives, including taking them, therapists with suicidal clients have a legal:
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•Duty to protect
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________ extends the duty to warn in California to a foreseeable, identifiable person who might be near the intended victim when the threat is carried out and thus might also be in danger
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•Hedlund v. Supreme Court
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Privileged communication does NOT apply in cases of:
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•Child abuse and neglect
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Which of the following would be an ineffective way of managing a client's suicidal ideation?
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•Be willing to communicate your caring without setting limits
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James is in court facing drug-related charges and his therapist was subpoenad to testify in court regarding any discriminatory evidence concerning the case. His therapist came to court but refused to answer questions regarding the case or produce James' records. The therapist used the following legal concept to protect himself from forced disclosure:
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•Privileged Communication
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Jolene tells her counselor that she is depressed about the break-up of her relationship and "just wishes she could go to sleep and never wake up." In this case, the counselor needs to:
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•Assess if Jolene is suicidal and intervene if necessary
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The HIPAA Privacy Rule was designed to provide a uniform level of privacy and security on the federal level. This Privacy Rule, which applies to both paper and electronic transmissions of protected health information by covered entities, developed out of the concern that transmission of health care information through electronic means could lead to widespread gaps in the protection of client confidentiality. Which of the following is NOT a requirement of The Privacy Rule?
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•It provides detailed patient information to individuals outside of the health care agency
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Bonnie became sexually involved with her therapist soon after therapy began. This action was initiated by the therapist who saw Bonnie's provocative behavior as an invitation to become intimate. Which of the following is NOT a possible on-going consequence for the client being sexually exploited?
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•Experiencing feelings of freedom and peacefulness
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In regards to boundaries in the counseling relationship, Lazarus takes the position that:
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•Certain ethics and boundaries actually diminish therapeutic effectiveness
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Which of the following statements about giving or receiving gifts is FALSE?
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•It could be more problematic to accept a gift at a later stage of a counseling relationship
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All of the following are true about bartering EXCEPT:
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•Bartering is illegal and unethical
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Which of the following situations does NOT have the potential to harm or exploit a client?
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•Setting healthy boundaries during the initial visit
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Joe has a counseling practice and is also teaching part-time. He is going to wait until the break to counsel some of his students. Joe would be:
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•In a dual relationship with his students, which may cause ethical problems
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Mentors often balance a multiplicity of roles. Which of the following would NOT be considered one of these roles?
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•Romantic partner
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A common reaction of therapists who realize that they have sexual feelings towards their clients is to:
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•Feel guilty, anxious, and confused
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In the authors' view, non-erotic touching between the counselor and client should be:
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•A spontaneous and honest expression of the therapist's feelings
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Boundary management is more challenging in _____ areas
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•More challenging in rural areas than in urban areas
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Leanne began to feel overwhelmed with her job at the counseling center. In addition to her regular duties, she was responsible for supervising all trainees. To manage her time, she spent a disproportionate amount of time with certain trainees and neglected others, assuming they had the skills to fend for themselves. If a client of one of her neglected trainees decided to file a lawsuit, it is likely that Leanne would bear:
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•Vicarious and direct liability
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Continuing professional education is important because:
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•A practitioner's level of competence may diminish over time; changes in laws pertaining to mental health, evolving ethical standards, and new trends in professional and evidence-based practices continue to be made
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The skills and training required to effectively and appropriately treat clients in a specific area of practice, and is both an ethical and legal concept, is the definition for:
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•Therapist competence
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When a practitioner has a license, he or she is:
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•Not competent to work with all populations
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In ________, the Supreme Court considered that the student had been informed of the faculty's dissatisfaction with her clinical performance, and the student knew that unless she made significant improvement in this area, she would be dismissed from the program. The Court held that the decision to dismiss the student from medical school was based on a careful and deliberate evaluation from the faculty, and thus the student's dismissal was not a violation of her constitutional rights.
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•Board of Curators of the University of Missouri v. Horowitz
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A primary aim of supervision is to create a context in which the supervisee can acquire the experience needed to become an:
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•Independent professional
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Signs of an impaired supervisor include all of the following EXCEPT:
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•Availability, accessibility, and being technically competent
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Which of the following statements is NOT accurate?
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•Supervisors are not expected to maintain records pertaining to their work with supervisees
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A school counselor was working with Quan, whose presenting problem was anxiety pertaining to academic success in college. This was within the scope of the school counselor's training. However, during the course of therapy, Quan became very depressed and engaged in self-mutilation and other forms of self-destructive behavior. Quan's counselor recognized that these symptoms and behaviors reflected a problem area that was outside the scope of his practice. Ethical practice required that the school counselor:
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•Make a referral to another professional who is competent to treat Quan's problems
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Confidentiality in online supervision is:
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•Filled with potential problems such as the possibility of computer-savvy individuals hacking into confidential communications between supervisor and supervisee and the risk of confidential content being sent or forwarded to others in error.
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