Section 7B: p. 383-449

Question 1

What is the difference between laws and ethics? (Section 7, p. 383)

ROBINSON article

Answer 1

Laws are based on the minimum standards tolerated by society. Ethics are based on the ideal standards expected by professionals.

Question 2

What is often seen as the primary means of protecting the self-determination and self-governing rights of clients? (Section 7, p. 383)

ROBINSON article

Answer 2

Informed consent.

Question 3

There are 3 factors that are required for clients to make informed consent. What are these 3 factors? (Section 7, p. 386)

ROBINSON article

Answer 3

Voluntarily - consent must be provided without pressure or coercion or powerful incentives.
Knowingly - counsellors must fully disclose information to clients so they are able to make an informed choice (including third party involvement).
Intelligently - clients must have the ABILITY to comprehend the conditions of consent.

Question 4

When should clients be informed of their rights and responsibilities? (Section 7, p. 391)

ROBINSON article

Answer 4

It is good practice to inform clients of their rights and responsibilities BEFORE entering into a counselling relationship.

Question 5

What are some of the benefits of engaging a client in the informed consent process? (Section 7, p. 391 and 402).

ROBINSON article

Answer 5

• Clients will feel more valued and respected for.
• Counsellors are viewed as more trustworthy, which can contribute to the therapeutic alliance, as well as counselling outcomes.
• By engaging the client in the process, it can also remove the power differenetial that exists between a client and counsellor.
• Promotes client autonomy and well-being (they can make an informed choice after hearing the risks and benefits).
• Minimizes risk for exploitation.
• Ensures the client comprehends the counselling process, as well as their rights.
• Protects the client (and the counsellor).
• Can create a sense of “we-ness”

Question 6

True or False: Informed consent is a discrete, one-time process that occurs at the beginning of the counselling relationship. (Section 7, p. 392).

ROBINSON article

Answer 6

False. Informed consent should be ONGOING and renegotiated throughout the counselling relationship.

Question 7

In the practical procedural framework, what is the difference between a continuous model of informed consent and an event model of informed consent? (Section 7, p. 393).

ROBINSON article

Answer 7

Continuous model - consent is a process (ongoing and collaborative); includes the idea of MUTUAL MONITORING: encourages each part to be sensitive to and monitor factors that may influence each other at any given time

Event model - consent is an occurrence (one time event) (most widely used by counsellors)

Question 8

Zuckerman (2008) offers 5 paths to informed consent (which are intended to structure and guide client-counsellor conversations during the informed consent process). What are these paths? (Section 7, p. 393).

ROBINSON article

Answer 8

1. Client information brochure
2. A question list to guide discussions
3. A summary of clients’s rights
4. An overview of elements and options in psychotherapy contracts.
5. Consent forms for treatment and other services that are tailored to various client populations.

Question 9

Counsellors do not always inform their clients of possible risks. Why might counsellors refrain from doing so? (Section 7, p. 394).

ROBINSON article

Answer 9

• They may not appreciate the nature and severity of the risks.
• They may not want to contribute to client anxiety.
• They may believe the clients will not understand the risks (and if they do understand the risks, this may deter them from engaging further in counselling).

Question 10

What are some reasons why counsellors may not inform clients of alternative treatment options? (Section 7, p. 394)

ROBINSON article

Answer 10

• They may not be aware of additional treatment options.
• They may fear they will lose clients if they cannot offer the alternative treatment options.
• They may not want to complicate the decision making process for clients who are already distressed.

Question 11

Informed consent is a process, not a ______________. (Section 7, p. 394)

ROBINSON article

Answer 11

Informed consent is a process, not a FORM. (Side note: a written consent form should always be accompanied by an ongoing verbal discussion of consent. The signed consent form will serve NO purpose if the client does not understand what they are consenting to).

Question 12

Informed consent can be described as a process which includes 5 steps. What are these 5 steps to assist counsellors in obtaining informed consent? (Section 7, p. 395-398)

ROBINSON article

Answer 12

Fit, Define Problem, Goals, Treatment, Follow up.

1. Counsellor and client will decide whether their is a mutual sense of “fit” to work comfortably with one another.
2. Once they have decided to enter the counselling relationship, they will define the problem.
3. Reach consensus on treatment goals.
4. Discuss with the client the treatment approach to help them reach their goal (should include the nature, purpose, risks/benefits of treatment, and alternative treatments).
5. Follow up (continue to inform client throughout the counselling process).

Question 13

What is considered the best practice in relation to informed consent? (Section 7, p. 402)

ROBINSON article

Answer 13

• Consent should be an ongoing discussion
• Consent should be in written form, in addition to verbal conversations
• Consent should be an engaging PROCESS (not a discrete, one-time event).

Question 14

What is a reason why consent should be ongoing and renegotiated? (Section 7, p. 403)

ROBINSON article

Answer 14

Issues, priorities, and goals tend to shift over time throughout the counselling process. Because information may change, the nature of counselling and treatment may change as well. New information may require new and updated consent.

Question 15

What are some situations where counsellors require informed consent from their clients? (Section 7, p. 404).

ROBINSON article

Answer 15

• Consent to treatment
• Consent for release of information
• Consent to have information shared with counsellor’s supervisor (or other 3rd parties)
• If counselling sessions are being recorded for training purposes, consent is required.
• If information is being shared to 3rd parties, and the client’s identity cannot be protected, consent is required.

Question 16

What are 5 ethical challenges related to e-counselling? (Section 7, p. 406)

ROBINSON article

Answer 16

1. Identifying which client concerns can be appropriately addressed via e-counselling.
2. The greater risk of communication misunderstandings (not able to observe non-verbal behaviours).
3. Maintaining professional boundaries
4. Electronic privacy/security issues.
5. The potential for counselling services to be interrupted due to technological problems.

SIDE NOTE: These concerns should be included in the informed consent process.

Question 17

True or False: Informed consent requires a written consent form, verbal consent, and documentation. (Section 7, p. 407).

ROBINSON article

Answer 17

TRUE.

Question 18

What are some helpful tips for consent forms and the informed consent process? (Section 7, p. 409).

ROBINSON article

Answer 18

1. Forms should include simple language/avoid jargon
2. Content of forms should be manageable (breadth and depth) - do not overwhelm the clients!
3. Forms are intended to supplement the informed consent process, rather than replace it.
4. Do not obtain the client’s signature until the consent process has been completed.
5. Answer all of the questions a client may has before signing the consent form.
6. The form must contain correct information.
7. Do not obtain consent from someone under the influence.

Question 19

When might verbal consent be more appropriate than written consent? (Section 7, p. 412)

ROBINSON article

Answer 19

When literacy, linguistic, disability, or other circumstances (such as cultural reasons) impede a written informed consent process.

*It may not be culturally appropriate to sign a consent form in some cases.

Question 20

What are the 6 criteria (Rozovsky, 2003) that must be met for consent to be valid? (Section 7, p. 414).

ROBINSON article

Answer 20

1. Clients must be legally competent to consent to treatment.
2. Clients must possess the mental capacity to authorize care.
3. Clients must receive a proper disclosure of information from the helping professional.
4. Client authorization should be specific to the procedure to be performed.
5. Clients should have an opportunity to ask questions and to receive understandable answers.
6. Client authorization should be free of undue influence and coercion.

Question 21

Based on the Lugenbuhl v. Dowling case (1997), what are the two aspects to the proof of causation in a lack of informed consent case? (Section 7, p. 417)

ROBINSON article

Answer 21

1. The plaintiff must prove that the defendant’s breach of duty was a cause-in-fact of the claimed damages OR the defendant’s proper performance of their duty would have prevented the damages.
2. The plaintiff must further prove that a reasonable patient in the plaintiff’s position would not have consented to the treatment or procedures had the material information and risks been disclosed.

Causation is established only if adequate disclosure reasonably would be expected to have caused a reasonable person to decline treatment.

Question 22

Describe the Schanczl v. Singh case (1987). Why is this important regarding informed consent? (Section 7, p. 423-424).

ROBINSON article

Answer 22

The case: Legal responsibility was placed upon the physician to ensure the patient (whose first language differed from the physician) adequately understood the information provided by the physician in order to obtain consent. The patient did have an adequate understanding. The physician was liable for failure to disclose material risks to the patient.

Why is this important: The key to consent is communication - professional MUST ensure their clients understand the information provided.

Question 23

According to CAP, why is informed consent exercised? (Section 7, p. 438)

Answer 23

To protect the integrity of the client and the psychologist’s professional relationship with the client. It is also a process through which permissions are obtained, boundaries are established, and professional rapport is built.

Question 24

Informed consent is identified most closely with what ethical principle? (Section 7, p. 438)

Answer 24

Principle I: Respect for the dignity of persons and peoples.

Question 25

Who does informed consent protect? (Section 7, p. 439)

Answer 25

The client and the psychologist.

Question 26

How does informed consent relate to Principle II: Responsible Caring? (Section 7, p. 438).

Answer 26

Clients must be informed of risks and benefits of treatment. They should only proceed if the potential benefits outweigh the potential harms.

Question 27

Documenting whether a client provided full, limited, or no consent is optional. True or False. (Section 7, p. 446)

Answer 27

False - everything MUST be documented!

Question 28

What can a psychologist do to ensure their client (whose first language differs from the psychologist) understands the informed consent process? (Section 7, p. 446)

Answer 28

- utilizing a translator or an interpreter

Question 29

According to CAP, what are some areas informed consent should cover? (Section 7, p. 442 and 446)

Answer 29

- purpose and nature of the activity - mutual responsibilities - confidentiality (protections and limitations) - benefits and risks - alternatives - likely consequences of non-action - option to refuse or withdraw at any time, without prejudice - period of time covered by consent - how to rescind consent

Question 30

If counselling a minor, a psychologist will need informed consent from their parents/legal guardians. They should also obtain _______ from the minor (Section 7, p. 446)

Answer 30

Assent

Question 31

What will reduce the likelihood of a psychologist being found culpable for an ethical or legal violation? (Section 7, p. 387) ROBINSON article

Answer 31

Engaging clients appropriately in the informed consent process (including an exploration of the rights and responsibilities of both the client and counsellor)

Question 32

What are counsellors obligated to inform clients about? (Section 7, p. 388) ROBINSON article

Answer 32

- the nature of counselling - limits, exclusions, and challenges to confidentiality - the rationale for the treatment approach - benefits and risks - alternatives - record keeping processes - fees

Question 33

What is the intention of informed consent? (Section 7, p. 389) ROBINSON article

Answer 33

To protect the client interests and to endorse the client's right to self-direction in a professional relationship that promotes attainment of client-identified goals.

Question 34

What is the Nuremberg Declaration? (Section 7, p. 390) What are the two ways that public is protected from healers? (historical perspective) ROBINSON article

Answer 34

A declaration that gave a new privileged position to consent, putting the control in the client's hands. The Nuremberg Declaration emphasized that voluntary consent of the human subjects is absolutely essential in medical research and treatment. Historical: Oversight (regulating the profession) and consent; consent was added during by Nuremberg Declaration

Question 35

What are some questions counsellors should ask themselves when engaging the client in the informed consent process? (Section 7, p. 398) ROBINSON article

Answer 35

- Do I possess a sufficient understanding of why this person wants my help? - Do I know what the client expects, hopes, or fears from counselling? - Does my client understand the concepts of knowingly, intelligently, and voluntarily, as they apply to informed consent? - Does the client truly understand the counselling approach I am intending to use? - Is the client truly aware of the risks/benefits - Is the client aware of alternatives? - When would it be appropriate to revisit/renegotiate informed consent?

Question 36

According to the CCPA Code of Ethics, under what circumstances should a counsellor tailor their informed consent forms/process? (Section 7, p. 410) ROBINSON article

Answer 36

- when clients are children - when clients are persons with diminished capacity - what a dual relationship cannot be avoided - when computer applications are a component of counselling - when counselling services are delivered by phone, internet, etc. - when services are provided for the use of third parties - when clients participate in assessment - when clients participate in research

Question 37

(Adequate Disclosure of information) Explain Canterbury v. Spence (Section 7, p. 415) ROBINSON article

Answer 37

Expectation that all information that a "reasonable person" would deem important to treatment decision making must be shared with a patient/client.

Question 38

Explain Reibl v. Hughes (Section 7, p. 415) | Adequate Disclosure of information

Answer 38

Informed consent stated that physicians should consider "what the average prudent person, the reasonable person in the patient's particular position, would agree to or not agree to, if all material and special risks of going ahead with the surgery or foregoing it were made known to him"

Question 39

Consent is based on a special relationship of trust often called a FIDUCIARY relationship; define this relationship ROBINSON article S7: p. 385

Answer 39

Fiduciary relationship: a relationship founded on trust/confidence relied on by one person in the integrity and fidelity of another. A fiduciary has a duty to act primarily for the client's benefit. Informed consent = acting in your client's best interest

Question 40

What are the main issues that need to be addressed in the consent process in order for client to make a truly informed decision? (3) ROBINSON article S7: p. 386

Answer 40

1) Info about counsellor's concept of problem (and alternative conceptions) 2) Info about alternative treatments 3) Specific consent (event model)

Question 41

What role to consent form play in the informed consent process? ROBINSON article

Answer 41

They SUPPLEMENT or AID the process of informed consent They support treatment of the client They protect the counsellor

Question 42

What are SMART Goals? S7: p. 397 ROBINSON article

Answer 42

``` Specific Measurable Attainable Relevant and Realistic Trackable and Time-limited ```

Question 43

The Code of Ethics requires counsellors to obtain appropriately tailored informed consent under which of the following circumstances? S7: p. 411

Answer 43

- clients are children - persons with diminished capacity - dual relationship cannot be avoided - computer applications are part of therapy - third parties will be involved - clients participate in assessment - clients participate in research

Question 44

How does Robinson describe informed consent with regards to coercision/involuntary clients? p. 419 ROBINSON article

Answer 44

All clients have the right to refuse servies: children, adolesscents, court-mandated clients For court-mandated clients, counesllors are not legally obligated to seek consent, but is helpful for rapport purposes *non-court mandated clients should be treated with same respect as court- mandated clients

Question 45

What wave of psychology does multiculturalsim fall into? ROBINSON article p.420

Answer 45

Multiculturalism is considered fourth force psychology (after psycho dynamic, behavioral, humanistic *all counselling is inherently multicultural

Question 46

What does the CCPA code advise for client's who may not be able to provide written consent?

Answer 46

"if written consent is note appropriate due to culture, literacy, disability, or any other legit reason, counselors should record the oral response to the informed consent process and document reasons for it not being written e.g. historical implications for indigenous clients signing forms Similar in CPA Code of ethics

Question 47

What does the case Schznczl v Singh say about linguistic capacity to consent?

Answer 47

Legal responsibility placed on physician to ensure patient, who's first language wasn't English adequately understood info provided regarding risks, benefits, etcs Still not does not play out in reality for many non-native English speakers