Eppp: Ethics And Professional Practice 4

Front 1

8. Of the following, which would not be inconsistent with a psychologist’s ethical obligations?

Beginning a sexual relationship with a cousin of a former patient who terminated therapy a year earlier.
Engaging in a sexual relationship with a patient who ended therapy two years earlier wherein therapy was not terminated for the intention of commencing this relationship.
Accepting a new patient with whom the psychologist had been sexually involved four years before.
Having a sexual relationship with a psychological assistant that the psychologist is currently supervising.

Back 1

Beginning a sexual relationship with a cousin of a former patient who terminated therapy a year earlier.

Hint 1

A. While there are several types of inappropriate relationships described in this question “A.” would not be inconsistent with a psychologist’s ethical obligations and is the correct answer. Ethical Standard 10.06 specifically mentions “current” clients or patients, but does not prohibit “former” clients or patients. “Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard” While sexual relationships with former patients are not altogether prohibited after two years (b.) in the Ethics Code, they are discouraged, and the psychologist would “bear the burden of demonstrating that there has been no exploitation.” Specifically, Ethical Standard 10.08 states “Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances.” Response choice (c.) is incorrect as Ethical Standard 10.07 states, “Psychologists do not accept as therapy clients/patients persons with whom they have engaged in sexual intimacies.” Ethical Standard 7.07 addresses (d.) “Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority."

Front 2

11. A psychiatrist sends you a release for information from a former patient of yours requesting records that are seven years old. In this situation, you should

send the records as requested.
send the records with a cover letter explaining the limitations of the records.
refuse to send the records.
contact the patient to make sure he or she understands the ramifications of the situation.

Back 2

send the records with a cover letter explaining the limitations of the records.

Hint 2

It is your responsibility to take steps to prevent the misuse of potentially obsolete data. At the same time, access to these records could facilitate the psychiatrist's work with your client, and the client does have the right to request the records. Thus, a cover letter explaining the limitations of the records (i.e., they are old and probably obsolete at least to some degree) is the way to go here.

Front 3

29. A psychologist learns from a friend that another psychologist has been revealing confidential information about his patients. Both psychologists live in a small rural community and the information the offending psychologist revealed has apparently spread rapidly around town. The psychologist who learned of this behavior should

call the other psychologist's clients to assess the degree of harm that their therapist's behavior caused.
seek consultation.
report an ethics violation to a state or national Ethics committee.
do nothing.

Back 3

report an ethics violation to a state or national Ethics committee.

Hint 3

You might have been looking for an answer such as “try to resolve this issue informally by speaking to the other psychologist”, but no such choice was present. Thus, you had to choose the best answer, and as with all ethics questions, the best answer is the one most consistent with the language of APA's Ethical Standards. The following excerpts from Ethical Standards 1.04 and 1.05 apply here: “When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved.” “If an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution ... or is not resolved properly in that fashion, psychologists take further action appropriate to the situation. Such action might include referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities.” In a nutshell, these standards say that, when another psychologist commits an ethical violation, your responsibility (assuming no confidentiality rights are violated) is to either bring the matter to the other psychologist's attention, or take action such as making a report to an ethics committee. Since this question does not include the option of addressing the issue informally, the best answer must be to report the matter to an Ethics committee.

Front 4

42. The difference between professional ethics and professional values is best stated by which of the following?

If a psychologist is ethical, there should be no difference between ethics and values.
Ethics are standards for practice set by the profession, while values refer to judgments of right and wrong.
Ethics can be stated more specifically than values.
Values specifically define appropriate professional conduct, while ethics are a more general code of proper professional conduct.

Back 4

Ethics are standards for practice set by the profession, while values refer to judgments of right and wrong.

Hint 4

Response B distinguishes between ethics and values. Values are concerned with what is good and desirable and ethics refer to correct or appropriate practice. Values and ethics are related in that the latter are usually derived from the former; for example, privacy is a value that is reflected in the ethical standard requiring psychologists to obtain clients' informed consent before releasing information about therapy. Responses A and C are not necessarily true, and answer D is not true since values do not specifically define appropriate professional conduct.

Front 5

45. To ensure that providers meet and maintain health plan participation requirements, managed care organizations (MCOs) use _____________________ as a review process.

clinical audit
concurrent review
credentialing
quality management

Back 5

credentialing

Hint 5

The formal process for determining if a provider meets and maintains the standards of qualification, as well as providing some legal protection for the managed care organization, is referred to as credentialing. Clinical audit (response “A”) is a quality assurance method. Concurrent review (response “B”) describes the utilization review conducted during the course of treatment. Quality management (response “D”) is another name for quality assurance.

Front 6

85. A 15-year-old boy is referred to the school psychologist by his teacher. The boy has recently been acting out in class, not finishing his coursework, as well as talking and joking during instruction. Although initially apprehensive to speak with the psychologist, the boy reveals that he is upset because his parents have been fighting for a few months as his father is angry at his mother for not working outside the home. His father has also been threatening to leave. The boy tells the psychologist his parents are private people and that he doesn’t want anyone else to know about this situation. Following the session, the referring teacher inquires what the boy said so that they can create a plan to help the boy. The psychologist should:

inform the teacher of what the boy shared because he referred the boy
inform the teacher of what the boy shared because he will use it to help the boy
inform the teacher of what the boy shared because they need to cooperate in helping the boy and both work at the same school
initially withhold what the boy shared from the teacher and speak to his or her supervisor

Back 6

initially withhold what the boy shared from the teacher and speak to his or her supervisor

Hint 6

D. Because the question doesn’t say anything about the policies or procedures at this school regarding the disclosure of confidential information to school personnel, you need to rely on the APA or CPA Code of Ethics to answer this question correctly. The Code of Ethics requires psychologists to maintain their clients’ confidentiality, unless they have appropriate permission to disclose information; the safety of the client or someone else is at risk; or a law mandates them to disclose information; and minors, like adults, are entitled to a confidential relationship with their psychologist. Additionally, this boy has explicitly told the psychologist that he doesn’t want anyone else to know about what’s going on at home. Therefore, the best answer we have available is that the psychologist should not tell the teacher what the boy disclosed. The psychologist may also want to talk to his or her supervisor to verify that the decision was right and determine what to do next. (Additional information: With a younger, school-age child, a psychologist has greater latitude in making this kind of decision: Under the parens partiae doctrine, a psychologist would have an obligation to act in the child’s best interests, meaning that she might decide to share information with the teacher or some other relevant party.)

Front 7

91. You are working as a psychologist in a hospital with a patient suffering from head trauma. In your presence, the patient develops Delirium. In this situation, you should:

bring more people into the room.
find a physician for a medication consultation.
stay with the person to provide support and help him remain calm.
recommend ECT treatment.

Back 7

stay with the person to provide support and help him remain calm.

Hint 7

This is a difficult question because it requires you to know about clinical management of Delirium and then to choose between two choices that are not bad answers. General principles of addressing an episode of Delirium include providing environmental support, manipulating the patient's environment in order to reduce confusion and disorientation, and giving medication if the patient is agitated, psychotic, or has insomnia. In other words, both B and C are good answers to this question. However, C is better for the following reasons: 1) Not all Delirium patients require medication; only if the patient is agitated, psychotic, or can't sleep at night is medication necessary, and 2) choice B implies that you would leave the patient to go find a physician. You should not leave a patient with Delirium alone, and even if a nurse or somebody else were available to stay with the patient, you should avoid sudden changes in a Delirium patient's environment.
Let's look at the other choices. Choice A, as phrased, is not a good idea -- bringing strange people into the room could increase the patient's sense of disorientation and confusion. Having a relative or other familiar person stay with the patient is a good idea, but choice A is not specific about what people you would bring into the room. Choice D, ECT, is actually used in rare cases for patients who do not respond to environmental manipulation or medication; however, you certainly would not recommend it right away. By the way, the primary treatment of Delirium -- addressing the underlying medical or substance-related disorder that is causing the symptom -- is not a choice here.

Front 8

123. A defense attorney contacts a psychologist to conduct an assessment of a client who has been charged with assault. Because the client does not have the means to pay, the defense attorney was hired by the family. The psychologist meets the client to perform the assessment however the client appears to lack the capacity to fully understand the reasons for the assessment. The psychologist should:

refuse to perform the assessment because the results would be invalid.
discuss the purpose of the assessment to the client.
obtain informed consent from the family.
obtain the informed consent from the defense attorney.

Back 8

discuss the purpose of the assessment to the client.

Hint 8

B. Ethical Standard 9.03(b) states, “Psychologists inform persons with questionable capacity to consent ... about the nature and purpose of the proposed assessment services, using language that is reasonably understandable to the person being assessed”

Front 9

160. A psychologist is working for a company that changes health care providers due to cost-effectiveness. The new provider has a policy that compromises the employee's future limits to confidentiality. The psychologist should

refuse to follow the new procedures and leave immediately.
outline her points of dissatisfaction and send it to the new provider.
make clear with each client the company's new limits to confidentiality.
organize a strike and call CNN.

Back 9

make clear with each client the company's new limits to confidentiality.

Hint 9

According to Standard 3.11 (Psychological Services Delivered To or Through Organizations), “Psychologists delivering services to or through organizations provide information beforehand to clients and when appropriate those directly affected by the services about (1) the nature and objectives of the services, (2) the intended recipients, (3) which of the individuals are clients, (4) the relationship the psychologist will have with each person and the organization, (5) the probable uses of services provided and information obtained, (6) who will have access to the information, and (7) limits of confidentiality. As soon as feasible, they provide information about the results and conclusions of such services to appropriate persons." If you choose answer A and leave abruptly, you are abandoning your client. You may also want to do answer B—outline your points of dissatisfaction—but this wouldn't be your first or most important consideration.

Front 10

175. Although you have extensive experience in administering the WAIS-R, you have not yet administered the WAIS-III. If you would like to administer the WAIS-III you should:

obtain additional training
obtain supervision by a psychologist experienced in the use of the WAIS-III
seek consultation to determine the most appropriate action to take
be able to administer the WAIS-III since it is very similar to the WAIS-R

Back 10

obtain additional training

Hint 10

Standard 2.01(c) (Boundaries of competence), requires psychologists who provide services involving populations, areas, techniques, or technologies that are new to them undertake relevant education, training, supervised experience, consultation, or study. When administering a test, or a new version of a test which you are not familiar with, the best course of action would be to obtain the necessary training.

Front 11

216. Which of the following statements regarding therapist-client sexual relations is, according to research, most correct?

Therapists treating clients with a diagnosis of Borderline Personality Disorder, Histrionic Personality Disorder, or who have a history of incest are more likely to become sexually involved with their patients than other therapists.
Therapists who become sexually involved with their patients are likely to have less formal education or to have received less professional recognition than other therapists.
Therapists who have completed a personal course of therapy are less likely to become sexually involved with their patients than therapists who have not undergone therapy.
Therapists who become sexually involved with a patient typically do so with a patient who is significantly younger.

Back 11

Therapists who become sexually involved with a patient typically do so with a patient who is significantly younger.

Hint 11

Kenneth Pope, in an appendix of his book Sexual Feelings in Psychotherapy (Washington, DC: APA, 1993), provides a review of the research in the area of client-therapist sexual relations. Only choice D reflects research findings -- one study found that the average ages of therapists and clients sexually involved with each other were 43 and 33, respectively; another study found these ages to be 42 and 30. In contrast to choice A, no research supports the notion that a particular diagnosis or history places a patient at greater risk for sexual involvement with a therapist. Choice B is also incorrect -- in fact, one study found that psychologists who had attained a high level of professional achievement reported a higher rate of sex with patients. Similarly, in regard to choice C, one study found that psychologists who had completed psychotherapy or psychoanalysis were more likely to have become sexually involved with a patient than those therapists who hadn't undergone therapy. According to Pope, the best single predictor of sexual exploitation in therapy is a therapist who has exploited a patient in the past.