1. Confidentiality 2. Boundaries (e.g.: dual relationships) 3. Payment Issues 4. Teaching/training issues 5. Forensic psychology issues Source: APA critical incident study in American Psychologist (Pope and Vetter, 1992)
1. Sexual or dual relationship 2. Unprofessional, unethical, negligence 3. Fraudulent acts 4. Conviction of crimes 5. Inadequate or improper supervision Source: Association of State and Provincial Psychology Boards Disciplinary Data Reports, August 1993 to July 1997
1. Sexual Impropriety 2. Incorrect Treatment 3. Loss from Evaluation 4. Breach of Confidentiality or Privacy 5. Diagnosis: failure to, or incorrect
I. Privacy and Confidentiality II. Informed Consent III. The Professional Relationship Multiple relationships Sexual Misconduct Abandonment Issues IV. Competence
CLINICAL – Based on your professional expertise. What do I know that can help my client with his/her mental, emotional, or behavioral condition? ETHICAL – Based on your professional ethical guidelines. How should I conduct myself? LEGAL – Based on state and federal laws. How do I avoid prosecution or becoming liable in a lawsuit?
Confidentiality: The ethical principle or legal right that a physician or other health professional will hold secret all information relating to a patient, unless the patient gives consent permitting disclosure.
Privacy: The state of being free from unsanctioned intrusion.
By respecting you clients’ right to privacy, you safeguard yourself against violating confidentiality standards and rules. Remember that the idea of confidentiality can be thought of as a key ingredient in the effectiveness of mental health treatment. Remember that unless you explicitly say so, those who come to you will assume you are going to protect their information.
Federal government (HIPAA) Texas law (Health and Safety Code) Ethic code/regulations of professional state board or credentialing entity Ethic code/guidelines of professional organization Personal code
Keep records in secure place (double lock) Have a list of exceptions in mind from the start and communicate them to your client in writing (e.g.: exceptions under law) Routinely use Authorization for Release forms as dictated by your treatment plan. Limit information to be shared. When consulting with others, leave out ALL identifying information. Forbid any non-professional talk of cases.
Mark client records with “confidential” stamp Get permissions from client on how communications can be made. Use caution in faxing material. Specify who is to receive fax, and mark “confidential.” Include note informing what to do in case fax was sent in error. Call to verify fax had been received. Be very, VERY careful when communicating by email. Attach caution note.
If you need to disclose information (e.g.: to insurance company for reimbursement) provide only the bare minimum amount of information needed. Other ideas?
Informed Consent: An agreement to do something or to allow something to happen, made with complete knowledge of all relevant facts, such as the risks involved or any available alternatives. Two parts: Initial (written, legally necessary) Ongoing (informal, helps guide treatment, protects integrity of the treatment process)
Who you are (name, credentials, etc.) Qualifications Services provided and NOT provided Potential risks and benefits of treatment Limits to confidentiality Payment/reimbursement details Client rights (e.g.: to terminate) Client responsibilities Complaint option and process
Utilize standard, comprehensive form before evaluation or treatment is started. Make SURE that potential client has understood the form. Verbally review key components with the client. Create tailored made addition to the form to fit the client’s or population’s unique needs/concerns (can be verbal or written).
Remember that as a mental health professional, YOU hold the power. The client is automatically vulnerable to your influence because of your role. Avoid dual/multiple relationships No sex or romantic interlude (before, during, or after) Seek clear beginnings and avoid lose ends
Dual (multiple) relationships: when a professional and a client take on additional roles with one another outside of the primary professional relationship. Such relationships can be benign, risky, or exploitive. In mental health, they are rarely benign, so best to avoid.
Friends Lovers Family Business partners Academic Student/Teacher Can you think of others?
Sexual misconduct within mental health professional relationship: Any behavior with the client or supervisee of a sexual nature, including (but not limited to): propositions for sex sexual jokes irrelevant probing of clients’ sexual history, thoughts, fantasies, or behaviors Irrelevant sexual comments Inappropriate and/or sexual physical touching
Get in touch and understand your own sexuality and needs for intimacy Regularly consult and/or seek supervision Know the warning signs: Emotional reaction to the client Amount of time spent with client or thinking about client Preparation in meeting with client Be willing to transfer clients or refer out Report all incidences
Don’t accept as a client a former sexual partner. Set a standard for self to NOT become a sexual partner with any client. Remember: By its very nature, sexual conduct within the therapeutic relationship IS EXPLOITIVE.
Abandonment: To withdraw one's support or help from, especially in spite of duty, allegiance, or responsibility. Remember, what you may see as appropriate termination, your client may see as abandonment.
Be clear in your informed consent process what expectations are in terms of termination of services. Prepare follow-up plan WITH the client in case of continued need for services. Prepare for termination WELL ahead of time. Facilitate any transfer of cases. Do follow-up contacts.
Avoid holding on to a case for fear of abandoning the client when the client is clearly not benefitting from your intervention. Make sure you CONSULT and DOCUMENT when things get murky or sticky.
Provide only services for which you have education, skills, and training to perform. Field Intervention Assessment Population Age group Condition
Professional’s Emotional state Emotional maturity Physical status Aversions Biases, prejudices
Keep up on your ongoing education and training Identify your weaknesses and limits professionally Identify your own biases, prejudices, and preferences Stay sober and make regular physical exams Consider counseling for self Be willing to transfer or refer out cases CONSULT, CONSULT, CONSULT