Question 1

When someone is required to attend a group, either by court order or as a result of an agreement, what are his/her options when it comes to participating in therapy?

Accepted Answer

Remember that just because someone is ordered to come to therapy does not mean that they will. Even when they do come, it is not a guarantee that they will engage the issues completely. Court-ordered clients normally have something attached to their attendance only, as courts would have a difficult time with confidentiality. So beware that even though a client may come, progress could be limited based on personal willingness.

Question 2

You have been treating Roberta for six months, helping her to grieve the death of her father. After the six months, Roberta shows significant signs of improvement. However, you want to make more progress with Roberta and would hate to lose her as a client. Your ethical obligation is to:

Accepted Answer

Whenever you are looking to extend therapy for your own personal benefit, either financially or for the professional experience and depth, you must remind yourself that this is not your therapy. The therapy belongs to the client who trusts you to make decisions as to when she's finished in therapy and depends upon you to be truthful in that.

Question 3

Your fee is $125/hour. Bobby calls, asking if he can stop by your office for an unscheduled appointment. Your last appointment of the day has just arrived, and you were planning on going home to a nice, relaxing evening. Ethically, how do you proceed?

Accepted Answer

When clients are in crisis, they will often show up at the door or on the phone, in an attempt to catch us when we are in the office. When it happens, your first step is to assess for emergency. If no emergency is present, you may proceed with assigning Bobby his usual weekly appointment time. If an emergency is present, you may follow your standard emergency protocol. But you always want to assess for emergency first, so that the client does not begin taking advantage of extra time.

Question 4

You have been helping your client, Shrinking Violet with issues of self-esteem, self-confidence, and social skills. You are beginning to see progress and ask her what progress she sees. She responds that "Therapy has changed my outlook; I finally have someone who cares about me and listens to me." What ethical question does her response present?

Accepted Answer

This can be difficult for someone who has never really had appropriate social relationships before. It looks like Violet sees you as her friend and not as her therapist. While it is not quite as harmful as other misinterpretations might be, you will want to re-draw the line as soon as possible for the client benefit. That way, as she continues to develop skills, she will be prompted to use them outside of the session to increase socialization.

Question 5

Reggie is a white male, 72 years old, who lives alone. You have seen him for three weeks when he begins to talk about how he misses his wife, how he wishes she were here, or that he could sometimes join her in heaven. Given Reggie's statement, your ethical obligation is to:

Accepted Answer

While all of the options seem like valid options to pursue, your ethical obligation lies with assessing for suicide. This is especially true given Reggie's demographic. He is 72, white, male and lives alone. When taken in comparison to the general population, Reggie is much more likely to be at risk given his presentation. Assessment is critical before he leaves your office.

Question 6

Laws surrounding the electronic transmission of healthcare data, the portability of healthcare insurance, as well as the registration of practitioners, clients, and other providers in a national identifier system are collectively known as:

Accepted Answer

While all of these acronyms have something to do with health, mental health, or health and human services and research, HIPPA is the only one that controls the portability of healthcare information from one provider or group of providers to the next. It has also made providers identify themselves in a national way, so that they can continue receiving reimbursement for many services. HIPPA stands for Health Insurance Portability and Accountability Act.

Question 7

During one of your sessions, a client begins asking about a certain medication that she has heard about that could be effective for her. Ethically, in order to stay within your scope of practice, you are able to discuss:

Accepted Answer

You are always able to discuss the importance of adhering to prescription medication, even if it was obtained from other providers. For many in psychotherapy, a change in medication could result in mood swings or behavior for which they are unprepared. As for how much medication and which would be more appropriate, that all falls to the psychiatrist.

Question 8

You make the following note in your records:
10 August 2004: Met with client in order to discuss the importance of developing more intimate relationships as it relates to his goal of having a more fulfilling personal life. Client was resistant to exploration of how much interest he has in developing relationships outside of his immediate family. Next appointment, 17 August 2004.
When it comes to record keeping, what is this?

Accepted Answer

Although short, the above example is a process note. It is process because it contains more than the "progress," that is to say, date to date record of when the client was seen. There is nothing that would indicate that this is a summary of treatment, since this client appears to have been seen for many weeks prior. Depth typically refers to the process of therapy, not especially to the content of the notes.

Question 9

When writing a summary of treatment, which of the following is generally not included?

Accepted Answer

A summary of treatment, since it is usually prepared for other professionals or other individuals in the care community, does not contain a great deal of detail, since professionals or others who are reading a summary of treatment recognize the importance of keeping the patient's details confidential.

Question 10

If a client presents with the following diagnoses and environmental factors, what issues could be seen as medically in need of treatment? Adjustment Disorder
Hypertension
Social stressors
GAF of 84

Accepted Answer

While this can be a slippery slope regarding client satisfaction, you must remember that you have objective ways in which to measure client satisfaction. Especially when it comes to pain, happiness, and sadness, you can turn to a 1-10 scale that will provide you with some valuable information. When the negative elements of said scale diminish to a point where the client can resume functioning, your job is complete.

Question 11

When a family is being treated as an individual unit, what control can a therapist exert on the behavior of one or more members in order to bring about the necessary change?

Accepted Answer

Change will come from within the family and while individuals can certainly contribute to how much they are willing to change, the family will need to change from the inside out when bringing about necessary change to the system. The exerting control isn't so much about what the therapist can do, so much as how the individual may choose to change.

Question 12

Maintenance of confidentiality in the family setting is:

Accepted Answer

It sounds simple, but it's true. Maintaining confidentiality with individuals is a lot easier than it is with families. After all, often times, families all present together. Keeping things "confidential" in a family setting where someone speaks out with the family present isn't possible. However, you do have the ability to determine how far you might press a certain issue if you know someone in the room has shared having a problem or reaction to that.

Question 13

When working with couples, a lot of stress and undue strain on the relationship can be avoided if the therapist has a ________ policy:

Accepted Answer

A therapist should always have a confidentiality policy and a no harm policy. Refunds for something where the client must put in almost as much as they get out can hardly be considered right. No secrets on the other hand, opens the communicative relationship, allows a couple to appreciate one another, and be open, honest, and truthful, knowing that whatever is revealed in therapy will be shared with both of them.

Question 14

As a family therapist, you will treat the family as a system. When working with a system, you are ethically obligated to:

Accepted Answer

Sharing everything across the system is impractical and in some cases, unethical. Talking to each person individually removes the essence of family work. Terminate treatment at the correct interval, yes, but you're obligated to do that with individuals and couples, too. Overall, when working with families, it will be hard not to develop therapeutic allegiances for the purposes of alignment and unbalancing. When creating these relationships, it is important to be honest about that.

Question 15

One issue that is not always considered when a family agrees to be seen together for family therapy is that:

Accepted Answer

Just because an individual is part of a system, he still has rights with regard to treatment, and those rights must be respected, even if they include the right to pull out at any time. All of the other options, while they may be sometimes true, do not always pan out for all involved in every case. But in the case of withdrawal, the right belongs to the individual.

Question 16

In order to aid in self-awareness, a practitioner who is working with LGBT individuals must:

Accepted Answer

Playing devil's advocate may not always help your clients; reflecting stigma is easy for some people, only because they have never known the opposite side of the coin, but we must keep in mind that we cannot expect our fellow therapists to change their mind with regard to moral stance, either. Instead, any therapist can choose to change their assumptions and attitudes to make for a more caring, responsible, helping professional.

Question 17

Which of the following is not a limitation of confidentiality? In other words, when must confidentiality be maintained?

Accepted Answer

Many may argue that all of these are cause to break confidentiality. However, an unplanned pregnancy does not fall into the category of being dangerous to self, dangerous to others, or others being a danger to you. Therefore, it is protected information.

Question 18

Which of the following might be one of the most important ethical considerations or limitations of telemedicine (i.e. online counseling)?

Accepted Answer

If considering telemedicine, it is extremely important to have a backup plan in the event of an emergency, or an inability to be present for certain aspects where person-to-person therapy works great, for example, assessment for psychiatric hold, emergency service request, etc.

Question 19

Involuntary commitment can sometimes be indicated when one presents with:

Accepted Answer

Involuntary commitment, also known as a psychiatric hold, can be instituted by medical personnel and others who have been certified to evaluate the severity of the situation and the ability of the situation to be remedied with or without emergency medical intervention. Suicidal ideation or intent is the clearest indicator for a hold.

Question 20

You have been treating Ben for about twelve weeks. After twelve weeks, it is determined that Ben must be hospitalized in order to stabilize. Ben is hospitalized for a period of three weeks. During these three weeks, Ben's psychiatrist and others have been trying to reach you, but have been unsuccessful. You are currently at risk for:

Accepted Answer

Abandonment is defined as not following up on a client who was in your care prior to admission and not participating in discharge planning or not following up with referrals for post-discharge use. While it may not impact the client, it impacts the ability of others to rely on you to provide timely, accurate, and appropriate care.

Quiz 2: Law Ethics