[Recommended] - chapter5

chapter5.pptx

Issues and Ethics in the Helping Professions
Tenth Edition
Chapter 5
Client Rights and Counselor Responsibilities

Learning Objectives (1 of 2)
5-1 Explain what is involved in the informed consent process.
5-2 Describe the basic content of an informed consent document.
5-3 Understand a counselor’s responsibility in record keeping.
5-4 Explore ethical issues related to online counseling.
5-5 Identify some legal issues and risk management strategies for providing online counseling.

Learning Objectives (2 of 2)
5-6 Discuss ethical issues in working with minors.
5-7 Address issues regarding suspected unethical behavior of colleagues.
5-8 Clarify what is involved in the concept of malpractice.
5-9 Examine the basis for malpractice liability in the therapy profession.
5-10 Delineate practical strategies for risk management.
5-11 Understand an appropriate course of action in dealing with a malpractice complaint.

Informed Consent
Involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it
Both an ethical and a legal obligation of the clinician
Not only meets legal and ethical standards but represents excellent clinical care as well
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

Content of Informed Consent (1 of 2)
The following information should be provided in writing and discussed:
The therapeutic process (including assessment)
Background of therapist
Costs involved in therapy
The length of therapy and termination
Consultation with colleagues
Interruptions in therapy
Benefits and risks of treatment
Using telecommunication technology

Content of Informed Consent (2 of 2)
Alternatives to traditional therapy
Tape-recording or videotaping sessions
Clients’ right of access to their files
Rights pertaining to diagnostic classifying
The nature and purpose of confidentiality

Record-Keeping (1 of 2)
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.

Record-Keeping (2 of 2)
From a legal perspective:
State or federal law may require keeping a record.
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.

Content for Inclusion in Records (1 of 2)
Client-identifying data
Client’s chief complaints
Physical exam objective findings
Intake sheet
Documentation of referrals and informed consent
Findings from consultations, referrals, diagnostic procedures and tests
Diagnosis and prognosis
Treatment plan

Content for Inclusion in Records (2 of 2)
Signed and dated progress notes
Appointment dates, times, and types of services
Termination and discharge summary
Release of information

Securing Records
Counselors have the responsibility for storing client records in a secure place and exercising care when sending records to others by mail or through electronic means.
Helping professionals who utilize the “cloud” as an off-site storage tool may be exposing themselves and their clients to unforeseen risks.

Ethical Issues in Online Counseling
It is the counselor’s responsibility to examine the ethical, legal, and clinical issues related to online counseling.
Basic issues such as self-disclosure, confidentiality, boundaries, and dual relationships can take on unexpected shapes in online counseling.

Mistakes of Omission in Online Counseling (1 of 2)
Obtain informed consent prior to services
Limit access to personal information
Obtain a clinical license to practice in the state in which the client resides
Comply with HIPAA confidentiality requirements
Respond in a timely manner

Mistakes of Omission in Online Counseling (2 of 2)
Terminating online services to clients abruptly
Claiming expertise in providing online services outside the scope of one’s education and training
Providing online services to clients whose clinical needs are so severe that they require in-person services

Some Advantages of Online Counseling
Reaching clients who are reluctant to participate in face-to-face therapy as well as those who have certain disabilities or chronic illnesses that render them immobile
Improving client access in rural areas
The potential for greater numbers of people to receive services

Some Disadvantages of Online Counseling
Danger of making an inaccurate diagnosis
Compromising confidentiality and privacy
Difficulty in protecting clients in crisis
Challenges of working through transference and countertransference
Lack of competence and danger of the misrepresentation of a counselor’s qualifications

Legal Issues and Regulation of Online Counseling (1 of 2)
A clinician’s license is intended for practice in the state where he or she is licensed to practice.
Counselors need to stay current regarding the changing laws pertaining to counseling across states.
Malpractice insurance carrier may not plan to cover out-of-state counseling.
Licensing boards have a legal mandate to protect consumers who live in their state; they do not have an obligation to consumers who do not reside in their state.

Legal Issues and Regulation of Online Counseling (2 of 2)
If a California consumer is traveling to another state and wants to participate in counseling via telephone (or online) the California-licensed therapists must receive permission from the temporary location.

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
Important issues to consider:
Limits to confidentiality
Dealing with reluctance
Need for supervised clinical experience in play therapy, art and music therapy, and recreational therapy

Unethical Behavior of Colleagues
Ignoring evidence of peer misconduct is an ethical violation in itself.
Many helping professionals are reluctant to address such problems.
Informal peer monitoring provides an opportunity for corrective interventions to ethically questionable acts.
If informal measures are not enough, reporting a colleague to a professional board is one of several options open to you.

Malpractice Liability
Malpractice means “bad practice.”
the failure to render professional services or to exercise the degree of skill that is ordinarily expected of other professionals in a similar situation
Professional negligence can result from unjustified departure from usual practice or from failing to exercise proper care in fulfilling one’s responsibilities.
Standard of care: Standards that are commonly accepted by the profession and are considered as the acceptable standard of practice in the community.

Elements of Malpractice
To succeed in a malpractice claim, four elements must be present:
A professional relationship between the therapist and the client must have existed.
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.”
The client must have suffered harm or injury, which must be verified.
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.

Reasons for Malpractice Suits
Failure to obtain or document informed consent
Refusal to counsel clients due to value differences
Client abandonment or premature termination
Marked departures from established therapeutic practices
Sexual misconduct with a client
Practicing beyond the scope of competency
Negligent assessment or misdiagnosis
Repressed or false memory
Unhealthy transference relationships
Failure to assess and manage a dangerous client

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 seek 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.

Course of Action in a Malpractice Suit (1 of 2)
Treat the lawsuit seriously.
Do not attempt to resolve the matter with the client directly.
Contact the ethics and risk management services of your professional associations.
Become familiar with your liability policy, including limits of coverage, and contact insurance company immediately.
Never destroy or alter files or reports pertinent to the client’s case.

Course of Action in a Malpractice Suit (2 of 2)
Do not discuss the case with anyone other than your attorney.
Determine support available to you from professional associations.
Do not continue a professional relationship with a client who is bringing a suit against you.

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