Ethics in Psychotherapy ]

2 of 30 Review of the Homework Trull: p Welfel: Ethics (chapter) Questions? Comments? How does this fit in?

3 of 30 Critical Thinking Moment What are ethics? Are they the same as the law? Why or why not? Are they arbitrary? Are they meaningful? Do we tell people why they can’t do certain things professionally?

4 of 30 Ethics These are the codes and rules that assist and promote safe practice The number of rules for psychotherapy are minimal This is the filter through which we view all client information and interactions

5 of 30 Ethics and the Law Ethics Codes are written by organizations Broader than the law Guidelines for practice Goal is to protect the client Typically occur at national level Law written by state or national legislature Vary from state to state These may or may not protect clients

6 of 30 Ethics and the Law The law and ethics sometimes clash Ethics codes state that psychologists and therapists need to adhere to the code of ethics and attempt to “resolve the conflict” Generally, psychologists and therapists protect the client first Best policy is to adhere to ethics codes and GET CONSULTATION!

7 of 30 Rules as Simple as You Can Get Rule number One Keep your pants on! Rule number Two When you are in doubt (including about whether or not to keep your pants on), get consultation Rule number Three From Hippocrates: First, do no harm (taking off your pants counts as harm)

8 of 30 General Ethical Guidelines Therapy that makes the client permanently worse is not ethical Therapy that makes things stay the same for a long period may be unethical Ethics impact the following issue Treatment Relationship Therapeutic contract Informed consent

9 of 30 Ethics Clients assume… that you’re practicing within your training that you are sensitized to the cultural issues they may bring that you are on their side Must tie together the client and therapist agendas to successfully set goals

10 of 30 Conflicting Values in Psychotherapy What do you do if you have a client who practices something that conflicts with your values? Know your limits Get consultation Refer Examples? Sexual orientation? Right to choose? Racism?

11 of 30 Ethics The ethics of seeing clients from other cultures and value systems Important for therapist not to make client become like the therapist Need to know what own values are as a therapist This gets challenging when it comes to successful acculturation

12 of 30 Ethical Prohibitions for Clinical Psychologists No dual roles with clients No sexual or intimate relationships with clients Note that as many as 25% of complaints are here No friendships with clients No working relationships with clients (employer- employee relationships) No sex with former clients for at least 2 years… WHY?

13 of 30 Ethical Prohibitions No dual roles with clients Why? Power differential Ability to react to client as client No competing contingencies

14 of 30 Ethical Prohibitions Limits of practice Therapist shall not provide treatments outside of his or her area of training oh, and no exorcisms

15 of 30 Ethical Prohibitions Testing Therapists shall not provide tests for which they are not trained Interpretive tests typically require a Ph.D. to administer and score Specific training involved Caveat for school psychologist with MS Basic rapid assessments only require knowledge of those tests

16 of 30 Confidentiality and Privilege Privilege – legal issue Client holds privilege and can decide who can know what information Different if the client is a minor (under 18) Caveats for clients over 16 under 18 Caveats for substance abuse treatment

17 of 30 Confidentiality and Privilege Confidentiality – ethical and legal issue Information transmitted from client to psychologist has the same right to confidentiality as that guaranteed between attorney and client Unless the client/patient signs a release which gives up the privilege of confidentiality for a particular purpose, the psychologist is not free to divulge such information to anyone

18 of 30 Confidentiality and Privilege Confidentiality We work very hard as therapists to protect confidentiality This is where another large group of complaints comes in (approximately 25%) – misconduct and violations of confidentiality

19 of 30 Exceptions to Confidentiality Need to let clients know through informed consent for treatment that there are exceptions to therapists keeping this confidentiality Not required by CA state law Mixed professionally

20 of 30 Exceptions to Confidentiality Reasonable suspicion of child abuse or neglect or elder abuse or neglect Burden of proof is not on psychologist Psychologist/therapist has reasonable amount of freedom to act here

21 of 30 Exceptions to Confidentiality Court-mandated treatment Requires proof of therapy and often reporting of facts (summaries) to authorities Involuntary commitment to a treatment center Psychologist presents specific evidence of behavior required for commitment Must maintain confidentiality over all information not relevant to commitment

22 of 30 Exceptions to Confidentiality Subpoenaed records Court evaluation Part of another law suit involving a client or former client Malpractice suit Psychologist is allowed to violate confidentiality in order to defend him/herself in court

23 of 30 Exceptions to Confidentiality Reimbursement from third party payers Limited to diagnosis and brief case information about progress This still has implications Labeling Stigmatization

24 of 30 Exceptions to Confidentiality Danger to self - Suicidality Immanent threat to self requires therapist to act Must protect person who may act on these thoughts Very personal decision, but not when client is in (or seeking) treatment, this belongs to the state Important to consider compromise of human rights

25 of 30 Exceptions/Limits to Confidentiality Danger to others - Homicidality Rule comes from Tarasoff Case Tarasoff v. Board of Regents Read case

26 of 30 Exceptions to Confidentiality Danger to Others - Homicidality Now counselors or therapists have a duty to warn intended victim and authorities Not protect them, but give them a chance to protect themselves Duty to break confidentiality Many complications have come out of this What if you have no way to contact victim Important to consider compromise of basic rights

27 of 30 Critical Thinking Moment Ethics of responsible practice What else? What have you learned so far? What should or could go in this list? How will this direct your services or the services you seek? Why is the law not part of these?

28 of 30 Critical Thinking Moment Ethics of responsible practice Providing informed consent for therapy as that therapist provides it Making sure the client understands his or her options Assessment Keeping track of improvements or problems Providing this information to clients

29 of 30 Critical Thinking Moment Ethics of responsible practice Providing “best practice” “Standard of Care” ESTs Getting consultation for assistance Consulting with clients about changing treatment plans Cultural competence

30 of 30 Useful Link