590 Unit 2 – Flashcards

*It is the counselor's ethical duty to protect private client information *Confidentiality is at the core of effective therapy

*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.

The constitutional right of individuals to be left alone and to control their personal information.

*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)

•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)

•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.

•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.

•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.

•Privacy requirements *Electronic transactions (fax) *Security requirements (rules how records are secured) *National identifier requirements

*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.

*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.

*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

•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

•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

•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.

•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

•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.

• Physical abuse • Sexual abuse • Psychological or emotional abuse • Neglect • Abandonment • Financial or material exploitation

•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

•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

•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.

•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

•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.)

*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

•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

•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

•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

*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?

•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

•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

•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

*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).

Supervision, consultation, and personal therapy

*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

*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

*Education *Training *Supervised experience *State and national professional credentials *Appropriate professional experience

•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.

•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.

•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.

*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

•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.

•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.

*Voluntary attempt by a group to promote professional identity *Sets minimum standards *Does not assure quality practice

*More serious than Certification *Governs professional practice *Highlights uniqueness of an occupation *Restricts both use of title and practice of occupation

*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

•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.

*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

•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

•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.

•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.

•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.

•LPCs who practice supervision are required to have relevant training experiences and course work in supervision.

*They tend to be available, accessible, affable, and able.

•Informed consent •Confidentiality and its limits •Liability *Direct liability *Vicarious liability

•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

*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.

•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.

*Pluralistic philosophy *Cultural knowledge *Consciousness raising *Experiential training *Contact with racial and ethnic minorities *Practicum or internship with culturally diverse populations

•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

•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.

•Privilege cannot be invoked if there are multiple people present

*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

•School personnel have a duty to protect students from foreseeable harm

•Jaffee v. Redmond

•Clear and imminent danger must exist

•Duty to protect

•Hedlund v. Supreme Court

•Child abuse and neglect

•Be willing to communicate your caring without setting limits

•Privileged Communication

•Assess if Jolene is suicidal and intervene if necessary

•It provides detailed patient information to individuals outside of the health care agency

•Experiencing feelings of freedom and peacefulness

•Certain ethics and boundaries actually diminish therapeutic effectiveness

•It could be more problematic to accept a gift at a later stage of a counseling relationship

•Bartering is illegal and unethical

•Setting healthy boundaries during the initial visit

•In a dual relationship with his students, which may cause ethical problems

•Romantic partner

•Feel guilty, anxious, and confused

•A spontaneous and honest expression of the therapist's feelings

•More challenging in rural areas than in urban areas

•Vicarious and direct liability

•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

•Therapist competence

•Not competent to work with all populations

•Board of Curators of the University of Missouri v. Horowitz

•Independent professional

•Availability, accessibility, and being technically competent

•Supervisors are not expected to maintain records pertaining to their work with supervisees

•Make a referral to another professional who is competent to treat Quan's problems

•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.