Law And Ethics

Front 1

Informed Consent

Back 1

-a client must be informed of anything that would affect his/her decision to enter/continue treatment
-including but not limited to, fee, cancellation policy, intern or trainee status, and the limits of confidentiality
-mandatory to inform of fees, cancellation policy, and trainee status
-limits of confidentiality (danger to self, others, child abuse, elder abuse, dependent adult abuse
-informed consent is the warning label for psychotherapy
-an ongoing responsibiity and should be mentioned throughout the course of therapy
-consent given based on the info. the person has
-ommissions are worse than mistakes
-no surprise fee

Front 2

Components of Informed Consent

Back 2

1) Competency of the client (aka capacity)- having the capacity to understand the info. therapist discloses (e.g. older people who may be senile, a child, a mentally retarded client). They also have the right to refuse tx, client can understanding purpose of tx
2) Disclosure of material information- fees, office policies, intern status
3) Understanding of Tx (Comprehension of information)- alternatives to tx, talk to them about what the risks, ramifications are of leaving therapy
4) Voluntary consent (aka Voluntariness)- the only time this occurs is when the clt is mandated- they can leave but you document it as non-compliant

Front 3

Exceptions to Informed Consent

Back 3

1) Situations that are life-threatening to the client
2) When a client is deemed incompetent to consent to tx
-General incompetence: actively psychotic, senile, severely mentally retarded
-Specific incompetence: actual ability to make a decision, a very specific brain dysfunction, a minor, need parental consent
3) Client's perogative- client not wanting to hear components of consent
4) Therapeutic privilege- only used when potential impact is severe, therapist's right to withold info from client

Front 4

Informed Consent: APA Ethics Code

Back 4

-use of language that is reasonably understandable to the client--excepting activities mandated by law without consent
-For individuals legally incapable: appropriate explanation, seek individual's assent, consider individual's preferences/best interests, obtain appropriate permission from legally authorized person, if required by law

Front 5

Informed Consent: APA Ethics Code

Back 5

-for court-ordered services, inform individual of anticipated services
-document written or oral consent
-in therapy without established techniques and procedures
-developing nature of the tx (applies when using some cutting-edge tx)
-potential risks
-alternative tx's
-voluntary nature of participation

Front 6

Informed Consent: Teledmedicine

Back 6

-no universal definition of telehealth
-all confidentiality laws apply
-informed consent has to be included in oth verbal and written before any telehealth services
-keep your services limited to the state in which you're licensed!
-patient must be present to constitute telemedicine

Front 7

Client Welfare

Back 7

A therapist must do what is in the best interests of clients- beneficence- is the clt benefiting from tx?
1) Mode of TX:should this clt be in family, couples, etc. therapy? is this mode of tx the best?
2) Duty to refer: when quality of standard of care cant be implemented, a psychologist should refer
-Fiduciary relationship between client and therapist: client's are under your care, obligation to act int he best interest of the other party, when client places special trust in therapist to use expertise, must act in their best interests

3) Dual relationships: interactions in which the client may be at risk for exploitation

Front 8

Client welfare: Professional boundaries

Back 8

Boundary violations vs. boundary crossing
1) boundary violation---> harm or exploitation, risk of harming or exploiting the client
2) sound clinical judgment is key
3) boundary violations are a frequent basis for ethics complaints and malpractice suits- constitute about half of ethics violations, mostly sexual boundary violations
Boundary crossing- self-disclosure, will it help the client?

Front 9

Client welfare: professional boundaries

Back 9

Common boundary crossings--self-disclosure
-gifts
-touching/hugging (always be mindful of how you touch your client)
-sales (might exploit your client)
-psychological voyeurism (enjoying particular stories more than others, be mindful of non-verbal cues
-intrusive advocacy (your own beliefs and politics being imposed on client, e.g. pushing a client to come out of the closet before they're ready)

-boundary crossings can be a slippery slope, when a therapist gets too self-interested
-therapeutic frame: structure of the work, quality and characteristics of your relationship w/ the client. when you deviate from your role, you're messing with the therapeutic frame

Front 10

Client welfare: Sexual misconduct

Back 10

-Civil Code- no sexual contact for at least 2 yrs following termination of therapy
-a major reason for loss of license
-therapist responsibilities regarding any client who has been sexually exploited by another therapist- dont break confidentiality, educate the client, pamphlet you can give to client

Front 11

Client welfare: sexual misconduct

Back 11

Four reporting options for therapist sexual misconduct:
1)Administrative action: filing complaint with therapist's licensing board- cant be done beyond 10 yrs, can suspend/revoke/probate your license
2) Criminal action
3) Civil action- person seeks lawsuit for damages incurred
4) professional association action- file a complain with apa ethics committee

-will usually start w/ 1 or 4
-then they will go for civil to get $ out of you

Front 12

Rule for competence

Back 12

must demonstrate adequate education

Front 13

Scope of practice

Back 13

can render any psych service to whom... individuals, groups, organizations
* what's the scope and to whom you can provide those services

Front 14

Necessity of license

Back 14

In the state of CA, in order to provide psychotherapy/counseling services for money, one needs a license
-you have to have a license to do therapy for money directly from clients
-working under your supervisor's license puts them at risk of you behaving unethically
-when you're a psych assistant, you're an employee of your supervisor's

Front 15

Scope of practice

Back 15

-what the law says you can do
-"...to individuals groups, organizations, or the public any psychological services
including but not restricted to: diagnosis, prevention, tx, and amelioration of psychological problems, and emotional and mental d/o's of individuals and groups

Front 16

Scope of practice

Back 16

*assessment distinguishes psychologists
-Compare with scope for other mental health providers
1) MFT's: focuses mostly on relationships, cant assess, cant offer services to organizations or general public like psychologists
2) LPCC: does not include family or couples, no projective techniques, no batteries of 3 or more. dont do cognitive impairment or criminal bx
3) LCSW: focuses on social adjustment and communities

Front 17

Competence

Back 17

-psychologists must demonstrate appropriate education, training, and supervised experience to provide services
-if not, the education, training, and supervised experience must be gained as quickly as possible or a thoughtful referral must be made- involves contacting potential people, ensure they're qualified and avaiable and document that u did this
-regular continuing education related to scope of practice
-more about what you say you're prepared to do
-find at least 3 qualified people who have availability
-you can work to get competence in an area you're lacking in-gain additional competence through supervision, consultation, and continued education

Front 18

Competence

Back 18

Three parts to competence
1) technical knowledge: knowledge of theory and interventions
2) Social skills- interpersonal sensitivity
3) Emotional well-being:
a) emotional competence-ability to withstand client's acting out-