Identify the 5 foundational principles which guide the translation of a “good theory” into decisions on behalf of client welfare, and occurring within the ecology of therapy:

1. Autonomy

2. Beneficence

3. Nonmaleficence

4. Justice

5. Fidelity

Principle that all human beings have the right to make decisions and act on them in an independent fashion.

Autonomy

Principle that one must actively attempt to benefit another in a positive manner

Beneficence

Principle that one must avoid causing harm to another

Nonmaleficence

Principle that all individuals should be treated fairly; equals treated as equals, and unequals treated in a way most beneficial to their specific circumstances.

Justice

Principle of commitment to keep promises, uphold the truth, and maintain loyalty.

Fidelity

Even with the best of intentions, ethical practice is a balance of risk and choice.  Some ethical concerns can be addressed by simply following the prescribed ____________, where risk and choice are minimized in favor of tradition and increased certainty.

By contrast, some concerns pose dilemmas with greater choice and accompanying risk. Resolving these dilemmas requires interpreting foundational ethical principles for ___________ by therapists.

Mandatory Actions (obligatory/prohibited)

Discretionary Actions

• Mandatory Actions (obligatory/prohibited)
• Discretionary Actions

Code of Ethics aid professionals in dealing with potential dangers from 3 groups:

1. Government
2. Professionals
3. Public

All professions desire autonomy and seek to avoid undue interference and regulations by lawmakers. Therefore, codes of ethics are designed to protect the profession from the government by…

Codes of ethics enables professionals to live in harmony by offering protection from potential…

• For example, it is unethical to entice colleagues’ clients to leave them.

… self-destruction occasioned by internal discord in the absence of such areas as common agreement. (institutional value-legitimate power couplet)

Codes of ethics protect professionals from the public for…

Each ethical standard reflects some element of the foundational ethical principles. Some code statements are definitive, institutionalizing professional values and including legitimate power of professions to discipline colleagues.

These types of standards concern mandatory actions or either: (2)

1. Prohibition (i.e. no sexual contact)

2. Obligation (i.e. maintaining awareness of personal values)

Mandatory actions are primarily designed to accomplish the principle of ________, which may or may not result in beneficence, or doing good for the client.

Nonmaleficence

It is in the area of discretionary actions that the professional acculturation of the therapist appears most critical to client welfare, in which decisions are made that are either aspirational or virtuous in nature. 2 principles are of critical concern:

1. Nonmaleficence

2. Beneficence

1. Clients, not therapists, take first priority

2. Therapist is competent to provide professional svcs

3. Therapeutic relationships maintained only as long as client benefits or referral is indicated

4. Ethical attention to client welfare cannot be assured when therapist's ability is compromised or hindered

1. Therapist Competence
2. Due Care

Essential element in client welfare, involving the infusion of knowedge, skill, professional judgment, scientific acumen, and supervised experience into care for clients, as well as use of reasonable discretion to maximize benefit and minimize risk.

• Represents professional values and promote expert power in care with clients

Competence

The exercise of an amount of skill common to the profession, without which the practitioner should not have taken the case, and a degree of care commensurate with this position; duty to act in good faith and advise patients regarding the best possible treatment.

• Involves monitoring benefit, adjusting approaches, vigilant commitment, and occasional referral or termination

Due Care

________ concerns the ability of MFTs to provide services w/ beneficent intentions for client welfare.

________ concerns  the obligations of the therapist to provide competent services to clients by initiating, continuing , limiting, and redirecting.

• Competence
• Due Care

Impairment

1. Self-Awareness
2. Cultural Responsiveness
3. Value Sensitivity
4. Good-Faith & Reasonable Effort
5. Client Benefit
6. Professional Limitations
7. Contemporary Knowledge & Skills

The ethical responsibility required of all national counseling organizations and some state licensing boards that nothing disclosed w/in the counseling session will be revealed to another person w/out the client’s expressed consent; often referred to as the “cornerstone of ethics.”

• Has become intertwined w/ legal constraints dictated by state and federal legislation and court decisions regarding privileged communication and privacy.

Confidentiality

2 reasons for maintaining confidentiality in psychotherapy:

1. Protects clients from the social stigma frequently associated with therapy

2. Promotes vital client rights, integral to therapists’ concern for client welfare

From the perspective of the legal system, confidentiality is generally viewed as an exception to the principle that…

…all relevant information should be available to judicial decision makers.

State and federal legislation, as well as court decisions, have increasingly mandated disclosure of information in certain situations, most notable in instances of ________________.

Child or Elder Abuse/Neglect

Legal exceptions to maintaining confidentiality represent institutional values that are supported by legitimate power to demand disclosures or impose penalties.

Thus, a thorough understanding of the limits of confidentiality in the therapeutic relationship prior to or at the beginning of therapy is a(n): (2)

1. Mandatory Duty

2. Essential Element of Due Care

To the extent allowed in legislation and legal precedents, clients are typically afforded the right to consent in regulating the disclosure of confidential information in a therapy relationship.

This situation is particularly compelling in applying the ethical precept of confidentiality when imposed w/ legal attempts to offset this cornerstone of psychological care. In such cases, _________ is a sig. consideration for therapists.

Privileged Communication

A legal right which exists by statute and which protects clients from having their confidences revealed publicly from the witness stand and during legal proceedings w/out their permission.

Privileged Communication

Where privileged communication laws apply, therapists are prevented from testifying in court about clients w/out their consent unless the client waives this privilege. This is because the privilege: (2)

1. Belongs to the client

2. Is meant for the protection of the client, not therapist

Essentially, privileged communication is the application of the ethical notion of confidentiality in a legal forum. It is important to note that privileged communication for the therapist-client relationship: (2)

1. Is not legally supported in all states

2. Can be subject to exceptions

Even when clients have not waived their right, privileged communication can be subject to exceptions such as when: (3)

1. one has been appointed by the court to secure information

2. one must defend against client allegations

3. criminality or matters of protection are involved

The freedom of individuals to choose for themselves the time and the circumstances under which the extent to which their beliefs, behavior, and opinions are to be shared or withheld from others.

• The concept is addressed by the 4^th Amendment to the U.S. Constitution, protecting one’s home against illegal search and seizure.

Privacy

The concept of privacy not only deals w/ communications, but also relates to: (8)

1. Disposal of records

2. Not being identified in a waiting room

3. Tape recordings

4. Use of credit cards for billing

5. Use of computer services for scoring tests or billing

6. Other documentary or business activities

7. Professional consultation

8. Supervision

Issues of privacy are particularly important when: (2)

1. Managed care agencies and other third-party payers attempt to gain access to therapy information

2. Therapists are bound by the law and/or professional codes of ethics to break confidentiality

Therapists should maintain a current record of third-party reimbursement requirements (i.e. insurance) in order to apprise clients of: (2)

1. The kinds of information that will need to be released (i.e. diagnostic labels)

2. Who may have access to the information

A curious tension has evolved in terms of privacy concerns for clients and the institutional procedures that involve technology.

As an overarching principle, professional values for the MFT…

By contrast, an overarching principle of institutional values for those employing technological adjuncts to therapy and case management is…

…respect for client privacy.

…access to and exchange of private client information.

In some governmental agencies and institutions, the therapist is not primarily the client’s agent. In these situations, therapists are faced with acculturation conflicts between: (2)

1. Professional Obligations to Clients

2. Institutional Obligations to Agency or Work Setting

Therapists may encounter circumstances in which compelling legal precedents overwhelm considerations of confidentiality and privacy.  Such is the case in instances in which therapist have a ___________, a position adopted by professional organizations involved with the practice of psychotherapy in which certain information must be revealed when there is clear and imminent danger to an individual or society.

Duty to Protect

Psychotherapists are not liable for failure to warn when the propensity toward violence is: (2)

1. Unknown

2. Would be unknown by other psychotherapists using ordinary skill

Set of procedures for therapists to follow if they determine that a client poses a serious danger of violence toward others: (6)

1. Inform clients of possible action they must take to protect third party in situations in which violence may be inflicted

2. Document everything observed and stated in session when client makes threats against others

3. Inform supervisor in writing of any serious threat

4. Consult w/ colleagues qualified to offer opinions on how to proceed and document

5. Alert police and other proper authorities

6. Notify intended victim; in case of minor, notify parents as well

Although a therapist, a person is still a citizen and they must protect and contribute to the common good. Therefore, a person of good conscience will not hesitate to warn and intended victim, or to prevent the continuation of child abuse, incest, or other forms of violence. These are not matters of discretion and virtue. Rather, they are matters of mandatory action reflecting professional values for: (2)

1. Nonmaleficience

2. Justice

Information given to clients in a package that includes an acknowledgement sheet that can be signed and returned to the therapist, containing information for the client about what will be expected of them, what they may expect from the therapist and therapy, and generally what their rights as clients are in order to assure that clients are adequately informed of their rights and responsibilities within therapy.

Informed Consent 

Informed Consent is designed to: (4)

1. Reflect the intentionality of the therapist

2. Provide a process of structure about mutual expectations in therapy process

3. Address issues related to financial obligations, scheduling, documentation & records, etc.

4. Establish an expectation that clients or consumers will be notifies of all actions related to disclosures of confidential information in therapy

3 types of information clients should have in order to make informed choices about entering into and continuing therapy:

1. Procedures, Goals, and possible Side Effects of therapy

2. Qualifications, Policies, and Practices of the therapist

3. Other available Sources of Help

Most therapists who recognize the need to educate clients about their rights and responsibilities employ some form of written document to introduce and record the implied contract that consent for treatment represent.

2 such types of written communication are:

1. Therapeutic Contract

2. Professional Disclosure Statement

Purpose of this document is to clarify the therapeutic relationship by defining therapy as a mutual endeavor to which therapists contribute their professional knowledge and skills and clients bring a commitment to work; encourages all parties to specify relevant goals, expectations, and boundaries, and considers such issues as

• Specific therapeutic approach and procedures
• Length and frequency of sessions
• Duration of treatment
• Cost & method of payment
• Provisions for cancellation/renegotiation of contract
• Extent of each party’s responsibilities
• Degree of confidentiality

Therapeutic Contract

Document which entails a process of introducing prospective clients to a therapists’ qualifications, the nature of the therapy process, and administrative procedures relating to time and money.

Clarifies aspects of one’s professional values related to worldview, practices, and professional acculturation by defining a set of competencies and an approach to identifying them as unique providers of beneficial human services.

Professional Disclosure Statements