Client Rights and Counselor Responsibilities Chapter 5 Client Rights and Counselor Responsibilities Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Client’s Right to Informed Consent involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it a shared decision-making process a powerful clinical, legal, and ethical tool requires that the client understands the information presented, gives consent voluntarily, and is competent to give consent to treatment a process that continues for the duration of the professional relationship as issues and questions arise Issues and Ethics - Chapter 5 (1) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Content of Informed Consent When educating clients about informed consent, the following information should be provided in writing and discussed: The therapeutic process Background of therapist Costs involved in therapy The length of therapy and termination Consultation with colleagues Interruptions in therapy Issues and Ethics - Chapter 5 (2) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Content of Informed Consent Clients’ right of access to their files Rights pertaining to diagnostic labeling The nature and purpose of confidentiality Benefits and risks of treatment Alternatives to traditional therapy Tape-recording or videotaping sessions Issues and Ethics - Chapter 5 (3) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Record Keeping From a clinical perspective, record keeping provides a history that a therapist can use in reviewing the course of treatment. From an ethical perspective, records can assist practitioners in providing quality care to their clients. From a legal perspective, state or federal law may require keeping a record, and many practitioners believe that accurate and detailed clinical records can provide an excellent defense against malpractice claims. From a risk management perspective, keeping adequate records is the standard of care. Issues and Ethics - Chapter 5 (4) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Content for Inclusion in Records Identifying data Fees and billing information Documentation of informed consent Documentation of waivers of confidentiality Presenting complaint and diagnosis Plan for services Issues and Ethics - Chapter 5 (5) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Content for Inclusion in Records Client reactions to professional interventions Current risk factors pertaining to danger to self or others Plans for future interventions Assessment or summary information Consultations with or referrals to other professionals Relevant cultural and sociopolitical factors Issues and Ethics - Chapter 5 (6) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Ethical Issues in Online Counseling It is the counselor’s responsibility to examine the ethical, legal, and clinical issues related to online counseling. Providing counseling services online is controversial. There are potential legal issues that must be addressed, a few of which include: Competence of practitioner in providing online counseling Informing client of limits and expectations of the relationship Developing a plan for how emergencies can be addressed Issues and Ethics - Chapter 5 (7) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Advantages of Online Counseling Reaching clients who may not participate face-to-face Improving client access in rural areas Increasing flexibility in scheduling Facilitating assigning and completing of client homework Augmenting a problem-solving approach Improving an orientation to the counseling process Enhancing the provision of referral services Issues and Ethics - Chapter 5 (8) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Disadvantages – Online Counseling Danger of making an inaccurate diagnosis Compromising of confidentiality and privacy Problems involved in being able to protect suicidal clients Difficulties in attending to clients who are in crisis situations Absence of traditional client-therapist relationship Inability to address a range of more complex psychological problems Inability to deal with interpersonal concerns in the therapy process Issues and Ethics - Chapter 5 (9) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Suggestions for Online Counseling Here are some suggestions for counselors considering online counseling: Before offering distance counseling, acquire the appropriate competencies related to this evolving specialty. Learn how to adapt traditional methods for effective application to distance counseling. Screen clients for suitability with respect to the specific distance services you are considering using. Issues and Ethics - Chapter 5 (10) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Suggestions for Online Counseling As a part of informed consent, educate your clients about the difficult situations that may occur during distance counseling. Familiarize yourself with the ethical guidelines that have been developed to inform your specific scope of practice. Be aware of the legal issues and state licensure board regulatory policies that govern your specific practices when delivering online counseling. Issues and Ethics - Chapter 5 (11) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Working With Children and Adolescents Important issues to consider: Minors’ rights regarding informed consent Parental rights to information about a minor’s treatment Minors’ assent versus consent Involving parents in the counseling process with minors Limits to confidentiality Dealing with reluctance Need for supervised clinical experience in play therapy, art and music therapy, and recreational therapy Issues and Ethics - Chapter 5 (12) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Elements of Malpractice To succeed in a malpractice claim: (1) a professional relationship between the therapist and the client must have existed; (2) the therapist must have acted in a negligent or improper manner, or have deviated from the “standard of care” by not providing services that are considered “standard practice in the community”; (3) the client must have suffered harm or injury, which must be verified; and (4) there must be a legally demonstrated causal relationship between the practitioner’s negligence or breach of duty and the damage or injury claimed by the client Issues and Ethics - Chapter 5 (13) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Reasons for Malpractice Suits Failure to obtain or document informed consent Client abandonment or premature termination Marked departures from established therapeutic practices Practicing beyond the scope of competency Misdiagnosis Crisis intervention Issues and Ethics - Chapter 5 (14) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Reasons for Malpractice Suits Repressed or false memory Unhealthy transference relationships Sexual misconduct with a client Failure to control a dangerous client Managed care and malpractice Issues and Ethics - Chapter 5 (15) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning

Risk Management The practice of focusing on the identification, evaluation, and treatment of problems that may injure clients and lead to filing an ethics complaint or a malpractice action. One of the best precautions against malpractice is personal and professional honesty and openness with clients. Know your limitations and remain open to seeking consultation in difficult cases. Remain alert for possible misunderstandings that, if not recognized or poorly handled, could lead to a therapeutic break or premature termination of therapy. Issues and Ethics - Chapter 5 (16) Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning