Scenarios and Responses Flashcards by Courtney Moeller

Delaying termination

issue and response?

Therapist Issue/Client dependence
competency/ dependency

response: unethical
process through personal therapy
consultation/education/supervision

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Countertransference?

Therapist Issue/Countertransference

process through personal therapy
consultation/education/supervision

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Pressuring client to make a decision

Therapist issue/manipulation

process through personal therapy
consultation/education/supervision

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client transference

Client issue/transference

process with client

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too many clients = stressed out

therapist issue/impairment or burnout

process through personal therapy 
consultation/education/supervision
self-care
boundaries 
possibly limit work

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telling client information about yourself

Therapist issue/self-disclosure

process through personal therapy
consultation/education/supervision

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giving advice

Therapist issue/value imposition
values = advice

dont impose values
process through personal therapy
consultation/education/supervision

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When clients values conflict with yours

Therapist issues/conflicting values

A. keep the case (therapy/consult)

B. Don’t Keep the Case
Criteria:
a. You have tried all of the previous suggestions

b. Your moral, religious or political values are centrally involved
c. Your boundaries of competence have been reached.

d. Yet still, you
I. have extreme discomfort with a client’s values.
II. are unable to maintain objectivity.
III. have grave concerns about imposing your values on the client.
IV. have countertransference which cannot be managed.
= Referral

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refer client to another therapist

Referral/abadonment

*always risk abandonment

must give 3 referrals

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you decide to go on vacation

Abandonment

need to include in informed consent
inform client ahead of time
need to provide substitute
document

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client wants to terminate therapy

Clients Rights/Termination

client has right to terminate
process with client to make sure they awnt to end therapy to avoid abandonment

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you are dealing with a client that you are not experienced with

Competency

training
education
experience

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client is of a different:

age
ethnicity
sexual orientation
SES

Diversity “Competency”/_____

process with client
understand client views/experience
consult/educ/supervision
personal therapy 
(possibly acknowledge/discuss limitations)

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Dealing with a gay couple

Diversity “Competency”/ sexual orientation

competency:
training
education
experience

Diversity: 
process with client
understand client views/experience
consult/educ/supervision
personal therapy

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client of different religion/spirituality

Diversity/Spirit or relig

ask permission prior to discussing
do FICA assessment
understand clients views/exp
incorporate into therapy/treatment

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change of fees

Clients rights/informed consent

discuss fees first
include in informed consent
cannot change agreement

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tried new treatment on client

Client’s rights/informed consent

must discuss risks/benefits prior
include it in informed consent

former client asks for records to be sent to another therapist

Therapists Responsibilities/Record Keeping

if it is within 7 yrs of termination:

respond within 15 days

minor wants to get treatment and

a. doesnt fit into exception
b. fits criteria

Therapist Responsibilities/Minor consent

a. process with minor
can’t consent to treat (parents)

b. 12-18, intelligent, rational, harmful if not treated 
birth control
pregnancy
drug
suicide
homicide
child abuse 
victim of crime

therapist doesn’t respond to client’s emergency

therapist responsibilities/malpractice

“Duty of Care” – Professional relationship exists (Therapist and client)
“Standard of Care”–Negligence by therapist
“Demonstrable Harm” – Harm which can be confirmed
“Proximate Cause” – Causal relationship of “b” and “c.”

client has medical issue and you do not refer them to a physician

Competency/referrals

client says they want to hit child

Crisis

forget modality
take control of situation
ensure safety
change treatment

client wants you to talk to their doctor

Confidentiality/ With Consent

process risks with client
get written release of info
share least amount of pertinent info

minor client is having sex

Confidentiality/mandated child sexul abuse

call child abuse center immediately
written report w/in 36 hours
change treatment
referrals: medical and support groups

client threatens to hurt someone

Confidentiality/Mandated "danger to others" ``` dangerousness assessment clarify if duty to warn and protect (if so, warn polica and victim) possible involuntary hold document change treatment ```

client is extremely depressed

Confidentiality/allowed "suicide" ``` suicide assessment ensure clients safety (involuntary hold) referrals (medication and medicine) document change treatment ```

you receive a subpeona about client

Confidentiality/Not an exception notify client try to get written relase of info respond but DONT GIVE INFO

you are court ordered

Confidentiality/allowable "court order" clarify committment to ethics try to resolve give only pertinent info

you consult another colleague about client

Confidentiality/allowable "prof consultation" 1. conceal client identity 2. share only pertinent info

hospital call about client serious health problem

Confidentiality/allowable "emergencies" 1. exception 2. give only pertinent info conceal identity

family calls concerned about client

Confidentiality/Not an exception can neither confirm nor deny info don't talk to them notify client get written release of info in order to talk

insurance wants clients info

Confidentiality/allowable "third party payer/insurance" insurance has right to info notify client of this include in informed consent

parent wants to know info about minor in therapy

Confidentiality/allowable "minor" parents have right to child info custody (clarify who has legal right to consent for treatment) consent (clarify who has custody to sign for consent) clarify confidentiality (what info you share with parent)

parent of minor doesn't have custody and 1. wants to pull minor out of therapy 2. wants information about therapy

Confidentiality/Minor 1. no custody = can't consent need written consent of legal caregiver 2. parents right to info about child share pertinent info only notify other parent

you begin seeing a family who wants to know info about others

Confidentiality/ Multiple clients inform no guarantee of confidentiality clarify secrets policy include both in informed consent

you're treating a minor and the parent wants to start couples therapy with her fiance

Multiple Relationships/Dual ROles clarify process rectify (possible referral) personal therapy/consultation DONT DO IT if it is exploitative or itnereferes with effectiveness

A client wants to pay for therapy in exchange for goods/services

Multiple Relationships/Bartering ``` allowed only if not exploitative if not, then determine value at onset determine length of agreement document in informed consent ```

friend of a friend wants to start therapy with you

Multiple Relationships/Social ``` risk of exploitation process with client rectify personal therapy/consultation DONT DO IT ```

therapist engages in sexual intimacy with current client and relative of client

Multiple Relationships/Sexual Relationship unethical to engage in sexual acts with current clients or people related to current client ``` process clarify take steps to rectify: personal therapy/consultation possible referral ``` it is always the fault of the therapist DONT DO IT

you go to a romantic dinner with a former client

Multiple Relationships/Sexual allowable if: 2 yrs post termination unusual circumstance therapist must prove it is not exploitative ``` DONT DO IT but therapist is always at fault former client always a client clarify, process, rectify personal therapy/consultation ```

you begin therapy with a former lover

Multiple Relationships/Sexual Relationship unethical to begin therapy with anyone you've been sexually intimate with process clarify take steps to rectify: possible referral / consultation it is always the fault of the therapist DONT DO IT

Client brings you a souvenir

Multiple Relationships/Gifts process what gift means and why clarify roles don't accept