Module 4: Confidentiality and Working with Diverse Populations

Question 1

What are the 3 basic guidelines for consent in the client/therapist relationship?
A. consent is informed, voluntary and discrete
B. consent is informed, private and discrete
C. Identify, describe and significant
D. consent is informed, voluntary and rational

Answer 1

Consent is informed - how long, fees, etc
Consent is voluntary - no coercion
Consent is rational - can client makes sound judgement

Question 2

What is autonomy?

Answer 2

Free Will (Kant). The right to make ones own decisions

Question 3

What are the guiding principles of autonomy?
A. justice, beneficence, integrity and self-care
B. justice, integrity, informed consent and shared decision making
C. obtain consent from clients and integrity
D. collect, record, disseminate and dispose of records

Answer 3

B. Justice, beneficence (doing good to others, includes moral obligations) integrity, self-care

Question 4

What term did the group change from to, but then decided to keep?

Answer 4

Informed consent - shared decision making

Question 5

What is honesty a component of?

a. informed consent
b. right to make ones own decisions
c. the integrity principal
d. the right to be left alone

Answer 5

The integrity principal

Question 6

When must the psychologist obtain consent?

a. they do not require consent
b. when the client is impaired
c. from all clients
d. only when the client is not impaired

Answer 6

From all clients for all types of work they undertake. Even when the client is impaired. Sometimes even so-called mature adults.

Question 7

Privacy is?

Answer 7

The right to be left alone and to their personal info

Question 8

Confidentiality is?

Answer 8

Collect, record, disseminate and dispose of in a manner that protects the information of the client, even after death

Question 9

Is it illegal to not disclose a possible threat from a client to others?

Answer 9

Not in Australia

Question 10

Fidelity

Answer 10

trust and reliability

Question 11

Is the promise of confidentiality ethical?

Answer 11

It is not ethical because the psychologist may not be able to deliver confidentiality

Question 12

What are the 3 basic concepts in consent?
A. integrity, intrusion and justice
B. unjust intrusion, right to control and access
C. informed, voluntary and rational
D. A & B

Answer 12

Informed (fees, procedures, etc)
Voluntary (no coercion)
Rational (clients ability to understand the relevance

Question 13

What are the 2 components of the right to privacy?
A. unjust intrusion in ones life and right to control records
B. collection of personal information and access to personal records

Answer 13

Unjust intrusion in one’s life and the right to control what happens to one’s records

Question 14

What are the 5 parts of the Australian Privacy Principal?

1. consideration, collection dealing with, the integrity, access and correction of personal information
2. consideration, collection dealing with, the integrity, risk of harm, written summary of rights
3. Risk of harm, written summary of rights, collection of personal info and rights and responsibilities
4. written summary of rights and responsibilities

Answer 14

Consideration of personal information
1. Collection of personal information
Dealing with personal information
The integrity of personal information
Access or correction of personal information

Question 15

Who do you contact if you suspect child abuse?
a. APAC code of ethics
b. APS code of ethics
c. APS ethical guidelines
D APAC ethical guidelines

Answer 15

APS ethical guidelines

Question 16

Legally obligated exposure (confidentiality)?

Answer 16

The client, legally, risk of harm and between colleagues without naming

Question 17

What is allowable disclosure?

Answer 17

Supervisors inspections as well as APS guidelines for working with clients when there is a risk of harm and suicide i.e maybe a legal authority by a school

Question 18

Who assesses for suicide risk over 25 years?
PSY team - Physical social team
CAT team - crisis assessment team

Answer 18

CAT team - crisis assessment team

Question 19

What are three myths related to violence?

1. That only violent or psychotic people commit murders
2. That only violent people, and mainly psychotic people murder and that it can be predicted
3. Only violent, abused and psychotic people murder

Answer 19

That only violent people commit murders
That people who kill are mainly psychotic
That violence is not something that can be predicted

Question 20

What are 5 items on the checklist that works 10% of the time?

Answer 20

Active symptoms or a serious mental illness (particularly hallucinations)
Impulsivity
Lack of insight or disconnection from reality
Lack of empathy or remorse
Poor response to treatments like anxiolytics (anti-anxiety drugs)

Question 21

What has been found to not be a risk of harm to others?

Answer 21

Paranoia

Question 22

What is a tool to assess the risk of harming others?

Answer 22

Historical-Clinical Risk Management - 20 (HRC020-C)

Question 23

What does a risk assessment clinician do?

Answer 23

He judges by experience and produces an estimate

Question 24

Structural professional judgement?

Answer 24

A judgement can be made on 1 risk factor but 2 factors being present is the best

Question 25

What is the COVE classification also known as?

Answer 25

The violence risk assessment guide

Question 26

Factor analysis found instruments tap what four overlapping dimensions? 1. violence, substance abuse, risk, symptoms 2. criminal history, psychopathy, irresponsible lifestyle, criminal attitudes and all substance abuse-related problems

Answer 26

2. criminal history, psychopathy, irresponsible lifestyle, criminal attitudes and all substance abuse-related problems

Question 27

Actural?

Answer 27

Measures risk

Question 28

How can group data powerfully inform?

Answer 28

Only by being part of a group may it be possible to tell whether something will happen. An example is the revolver choice. Would I pick the gun with 4 empty cartridges and 1 full or the other way around

Question 29

One crucial point of a mixed treatment and assessment approach is?

Answer 29

Not enough to say a variable is a risk factor but also to show that a variable reduces the risk. i.e. someone is a risk, so steer them towards suitable employment

Question 30

Novel assessment methods?

Answer 30

Use implicit measures (suggested though not directly expressed) or heuristics (mental shortcuts)

Question 31

What are the 5 approaches to risk assessment by Skeem and Monaton

Answer 31

Unstructured clinical judgement The standard list of risk factors HCR20 COVR & LSI-R and VRG

Question 32

Having read Skeen and Monatans review of the 5 methods, what is the optimal method for predicting the risk of violence?

Answer 32

They state that the unstructured clinical judgement method has the least empirical support, potentially leading to inaccurate prediction of violence. However, studies provide little evidence that one validated instrument predicts violence significantly better than another, essentially being interchangeable with estimates of accuracy falling within a narrow band. Instead, they argue for group-based assessments and the differentiation between risk assessment and risk reduction as a goal.

Question 33

What is the optimal method for predicting violence?

Answer 33

Margins of errors surrounding risk assessments of violence are so wide as to make predictions "virtually meaningless" or group data can powerfully inform individual assessment of risk.

Question 34

What are some controversies surrounding the empirical assessment of risk?

Answer 34

Error margins, the lack of differentiation, between instruments which suggest they all measure common factors and these factors may not necessarily be valid or reliable indicators of risk of violence, the potential for empirical measures to assess psychopathy and antisocial personality traits rather than the risk of violence, the dichotomous nature of risk prediction (e.g. violent/non-violent) when a continuous measure may be more appropriate; the differences between individual and group prediction, and the apparent confusion between the goals of risk assessment and risk reduction.

Question 35

Empirical?

Answer 35

Verified by observation or experience rather than theory or logic

Question 36

In suicide what must a psychologist be aware of?

Answer 36

Counter transference reactions, such as pity, fear, anger, panic, moral offence or need to save the client

Question 37

What are Gerards 3 categories?

Answer 37

1. The chronically ill, in pain or disabled, with a common factor of helplessness. 2. Those who have experienced severe trauma and are now chronically depressed. 3. Those who use suicide as a last resort to show their pain.

Question 38

Suicide levels?

Answer 38

High risk - face to face assessment within 24 hours Medium risk - face to face assessment within 1 week Low risk - currently unwell or distressed - within 1 week no current problems - within 1 month or 7 days of leaving acute inpatient unit.

Question 39

What are 3 common reactions that psychologist experience to their patient's suicide

Answer 39

shock as a burden a personal crisis, including guilt, doubt and fear

Question 40

Fidicury relationship involves?

Answer 40

Trust

Question 41

Communication technology can lead to?

Answer 41

Increased cognitive effort, decreased understanding and poorer interaction quality than if it was face to face

Question 42

Psychologists feel more comfortable with the: law code

Answer 42

code

Question 43

What percentage of psychologists felt it was their legal duty to disclose if there is imminent danger, even though it is not illegal in Australia

Answer 43

64%

Question 44

What is the life expectancy of indigenous Australians?

Answer 44

19 years lower than non-indigenous

Question 45

What are the 3 skills required to develop culturally proficient psychologists?

Answer 45

Attitudes: know your personal beliefs regarding cultures and monitor personal biases Knowledge: Own and others world views. Socio-political influences such as discrimination and stereotyping, know historical practices, norms Skills: to interact with diverse clients, skills are not culture-bound. Adaptable can work with interpreters

Question 46

Ethnocentrism?

Answer 46

Not having preconceptions as per own culture

Question 47

How many diverse groups in Australia?

Answer 47

Over 200 countries represented and languages other than English

Question 48

What is difficult for interpreters and psychologists

Answer 48

Explaining tricky concepts that do not translate easily, i.e hallucinations or medications

Question 49

What should be taken into account when employing an interpreter?

Answer 49

Learn, allow 10-15 mins prior to the session to brief the interpreter, respect confidentiality, match for gender, age or religion. Avoid relatives and children. Allow 10-15 minutes to debrief the interpreter. Caution when using interpreted tests.

Question 50

What are some of the issues of using an interpreter?

Answer 50

Interpreters may not have had training and may be adversely affected or traumatised With a slow pace (interpreting) could lose concentration Transference and countertransference can interfere It May take too long

Question 51

Therapeutic Triad when using an interpreter

Answer 51

A triangle or interpreter behind the client

Question 52

What are the 4 modes of interpreting?

Answer 52

``` linguistic mode (word for word and interpreter stays in a neutral and distanced position) Psychotherapeutic of constructionist mode (this is where the meaning or feeling of the words is more important) Advocate or community interpreter (advocate or represents the interests of the client) Cultural broker/bicultural worker (the spoken word plus cultural and contextual variables) -Contextual meaning relates to the circumstance, setting, idea, etc ```

Question 53

If the interpreter is slow what might happen?

Answer 53

The psychologist may lose their thread of what is being said. To counter this it is best to have open communication, and trust to create a natural rhythm that makes everyone comfortable.

Question 54

What is back translation?

Answer 54

This is where one translator translates from a language to another and another translator translates it back. Important for legal cases.

Question 55

What are some problems with Psychometric tests?

Answer 55

Not adapted for the particular culture. Reliability, validity and norming. If not done correctly then it is compromised, i.e in African cultures distress may be interpreted differently or have a different meaning.

Question 56

Culturally inclusive practice

Answer 56

7 million people worldwide are refugees, asylum seekers, internally displaced or stateless. Australia hosted only 0.3% (30,000) of the 80% of the world refugees, particularly Pakistan and Iran.

Question 57

Conventions relating to the status of refugees

Answer 57

Under these, it is legal to seek asylum regardless of how one arrives in the country

Question 58

Some effects of trauma and torture?

Answer 58

Identity confusion, lack of trust, grief and loss, mistrust and fear of authority, chronic pain, cognitive impairment

Question 59

What are some of the problems for psychologists working with homeless and poor people?

Answer 59

They may ask for money for food and cigarettes | May be living in a car with a toddler

Question 60

These are stereotypes of gay people, these are the realities

Answer 60

`1.sexual orientation and paedophilia are not the same 2. children raised by GBTQ do very well 3. cross-dressing as a fetish and transgender are different 6. Same-sex is not something to be cured of 4. Bisexuality can be lifelong or part of coming out 5. LGBT have similar relationships (i.e lifelong) to any population 6. LGBT should have the same rights as everyone

Question 61

Your career: 2 outcomes of learning and applying psychology

Answer 61

1. Reflect and learn from one's experiences to be able to express feeling as in the psychology principals 2. Apply the principles to promote ones own development through self-regulation to attain goods, etc

Question 62

Socrates said:

Answer 62

An unexamined life is one not worth living

Question 63

What is practice or praxis

Answer 63

Doing something based on theory and reflection | Wisdom (phronesis)

Question 64

Praxis, phronesis

Answer 64

Informed by a moral disposition to act rightly understanding other people in context

Question 65

Canonical (Schon)

Answer 65

accepted in law

Question 66

Schon advocates two domains

Answer 66

Reflection in action (at the moment, because these are standard solutions) i.e a client brings up something which the psych refers to their toolbox to answer and Reflection in action (happens afterwards in hindsight) i.e psych goes over and evaluates what happened

Question 67

Reflection

Answer 67

reflection helps you learn and requires concentration, evaluation of which skills are required. It can be quite uncomfortable. Requires honesty and from different perspectives.

Question 68

Autoethnographic ethic

Answer 68

Diary of self-reflection often used to train health professionals

Question 69

Bakers 4 steps model for reflective writing

Answer 69

1. identify - select experience 2. describe - what are your thoughts, feelings 3. significance - what have you personally got out of this experience 4. what are the implications or how did it impact you

Question 70

What are the 3 basic guidelines for consent in the client/therapist relationship

Answer 70

Consent is informed - how long, fees, 3rd parties, confidentiality, etc Consent is voluntary - no coercion Consent is rational - can client make a sound judgement