Desiree Thomas PSY 570 Notes 9/27/11 Ethics-(Ceiling) The study of what constitutes good and bad human

conduct. Beliefs we hold about what constitutes good conduct. Standards of right and wrong. Ideal goals that you aspire to meet. Ethical codes- Standard of right conduct for a particular group (Social workers, psychologists, school psychologists, lawyers, doctors) Difference between Values and Ethics- Values more personal, ethics are standards that apply to a group of people. Values- Personal beliefs and attitudes that guide our actions/decision making. Core personal beliefs that provide you direction in life. Difference between Morals and EthicsMorals- Standard of right and wrong within a culture. Really have an evaluative component. More a value judgment placed on morals, they are immoral. Cultural standard of right and wrong. Morays- Community norms, whats expected within a community. Whats normal? What does everybody in this particular community do? Laws- (Floor) Specific policy passed by the government, if you violate law you must face sanction or punishment, if you break that law. The minimum standard of acceptable behavior If you break the law youve gone below the standard of acceptable behavior and you need to be sanctioned. Laws and Ethics- Can go together but can also conflict Mandatory Ethics Vs. Aspirational Ethics Mandatory Ethics- Following the letter of the law. Am I following the rules? Following the rules because they dont want to get in trouble. Safe because they are following the rules. Aspirational Ethics- Spirit of the law. Always asks am I doing the best thing possible? Not just for myself but for my client. Spirit behind mandatory child abuse reporting law is to protect the child. Can be powerless and need someone to protect them.

Law protects mandatory reporters. If you follow the rules and report every single time you are safe, but aspirational ethics asks is this course of action the best to uphold the spirit of the law. Principal Ethics (Mandatory Ethics) Vs. Virtue Ethics (Aspirtational Ethics) * Pricipal and Virtue wont be on the test. A good therapist has to be able to find balance between the 2. You have to know the rules and principles and ask yourself what should I do? However, you also have to ask whats the best for the client, whats the spirit of the law. As a therapist you should strive to integrate the 2. Most of the principles we have because of problematic situations, Why do we have them? to protect client, and to let public know what organizations stance is, also to protect professionals and the organization, helps communicate to the public what we do, to guide us in our decision making (give us standards for what to do and what not to do), have them for accountability (hold us accountable for our conduct as professionals), enhance the status of the profession (makes us look more professional) Ethical Codes and Laws do not tell you clear cut answers as to what you should do Number one priority of the decisions you make should always be in the best interest of the client. Other decision making factors are: Level of experience You are not protected if you dont report. If it comes out that you didnt report you can go to jail, fined, lose your license or all of the above. How you handle situations varies based on: experience personality, (i.e. Lori drove her client home, because of control, she wanted to handle the situation herself). Theoretical orientation Values Biases Steps to ethical decision making: 1. Identify problem or dilemma (Gather enough information as you can) 2. Identify the potential issues involved

3. Review the relevant ethic codes (not memorize) 4. Know the applicable laws and regulations (legal side) 5. Obtain consultation (need to consult with other individuals and get feedback as to what they think) Important because its a good way to measure your own judgment Get new perspective, may be things youre not thinking about or seeing Good risk management (Didnt make decision in isolation, talked to expert in the area) 6. Brainstorming (thinking of all possible options, can also be used in consulting) 7. Evaluate each of the options 8. Make a decision (Book: Choose what you think is best course of action) PICK ONE 9. DOCUMENT Document all of your notes, often times its the only evidence you have (to a jury if its not written down, it didnt happen) Mantra of the quarter- CONSULT & DOCUMENT Obtain Consultation for us beginners 1. Supervisor (is liable) 2. other colleagues(not liable) (thats why you stay connected!) Moral Principles that to Guide Decision Making : 1. Autonomy- Client has the right to make his or her own decisions .Can have client weigh pros and cons give guidance but client makes decision 2. Nonmaleficence- Do no harm 1. Beneficience- Doing whatever we can to promote well being of the client, doing what is in best interest of client Justice-Fairness. Treating every client equally. Dont let your own personal values or biases interfere in order to be fair. Dont discriminate or oppress. (Doesnt mean you do everything the same for every client because people differ) Fidelity- Honoring your commitments (Fulfill our responsibilities in the professional relationship, i.e. if I promise to be here at 2 or lower rate I will and I will not come back and say you owe me etc.) Veracity- Be truthful and honest in dealings with our clients. (Doesnt mean you have to tell them every detail or answer every question that they ask you) 10/3/11 Chapter 3 3 things feel very passionate about, get you emotional -Racism -Abuse -Neglect 3 core personal values

-Respect- I feel we all need to respect each other and I also feel that I deserve respect. I was taught from a young age by my father to respect others but also that no matter how old I am I deserve respect as well and if Im being treated unfairly I need to stand up for myself. -Honesty- Coming from a lot of life situations that have centered around lies and mistruths I value honesty very much. Whether it hurts or is uncomfortable to hear I believe that we need to be honest with those we care about. -Compassion- I am a very caring person and I do all that I can for my fellow person. Compassion I feel is something that many lack nowadays. Many are out for themselves and compassion to me means looking out for others as well as yourself. It is a beautiful thing. Ethically its not okay for therapists to impose their values on their clients. Dont let our values impact therapy, have values but dont let values negatively impact your work with client. -Get supervision (consult) -talk about it with colleagues (consult) -take care of it in your own therapy You arent going to be able to work with everyone -not competent -personal reasons why you cant work with every single people Im sorry I cant work with you, here are 3 referrals, I will continue to work with you until you have had a reasonable amount of time. -At least 3 good referrals -Reasonable amount of time -Document that you made a good effort to connect with someone else, if they didnt follow through thats their responsibility. There are values inherent in the process of therapyWe Value Self Disclosure in Therapy -introspection -self disclosure -Understanding thoughts or emotions MFT value looking at system rather than individual Within systems therapy the belief is the best way to help is to treat the whole family. If youre not treating whole family system is going to work because it is going against what you are trying to do. -Dr. Barker would try! Call if she got release of info and say I need your help to see whats going on from your perspective, i.e. best interest of child, important part of this family.

Need to report- Child Abuse, Elder abuse, Suicide, If client has told you they are going to kill someone (not if they already did), Imposing values. legally as therapists we have to prevent abuse, suicide, domestic abuse We dont have any legal obligation to report illegal activities i.e. substance abuse, domestic violence- Client could sue, under no legal obligation to report , its happened and clients have won from jail! Domestic abuse- okay to educate and say what youre going through is not okay, can work with on a safety plan (do you have a bag packed, extra money, shelter or friend just in case), one of the instances when they do get more involved. Another instance. . . Substance abuse- can psychoeducate, pros and cons, can refer if you think substance abuse is to out of hand for you to work with. Dr. Barker 2 rules -Treatment Program (i.e. AA) -Cant come in drunk or high (we cant have session today you have to go) Terasaw(?)- Im going to go home and beat my wife silly, yes report. Chapter 2 Might feel incompetent that client is chancing -impatient -frustrated -irritated -angry -exhausted Youre not always going to get good feedback from clients -they might not come in and thank you -may not be able to see change - most days you wont see any change -as a therapist must need internal resources and internal motivations -baby steps, something small like a smile may be the only change you see -Must be able to get rewards from other places. Feedback from clients cant be your only resource of reward. - Sometimes just sitting and listening needs to be enough, even if you dont see change - -Therapy is planting seeds, may not see plant grow -Avoiding burnout- Hard to talk about problems all day long, its exhausting , a lot of mental energy goes into listening to the person. Very draining. -Clients its one way, you are there 100% for them. -Must find pleasure in other things i.e. exercising -Dont give up on things you enjoy. Start habits now so you can hold on later

-Personal Therapy- Not always required but recommended Work out your own issues Everybody has problems, as therapist are you commited to working on your problems. You cant take your clients any farther than you have been willing to go. Empathy- gives you insight to know what it feels like being in client chair. Understand what your client is going through -More reasons to get in your own therapy, look in book. -At school or private practice or insurance 10/5/11 Client dependency- Goal is for clients to be autonomous and independent. Client should not be too dependant on therapist -ideally negotiate termination, mutual agreement with client about when you terminate. -looks like client is doing well all goals are met, therapist brings up termination -Client negotiates termination -Clients may not want to terminate Terms originally come from Freud. Frued originated but now pretty much every therapeutic orientation agrees about transference/ counter. Transference- Dont actually believe therapist is that person. But they interact with therapist based on some other significant person in their life. i.e. if they had an overly demanding father they may overreact to therapist by saying you are too demanding, based on issues with father. Counter TransferenceBraod Definition-Any reaction that therapist has to the client. 3 different types: Client triggers your own issues, Something client is doing or saying is triggering therapists own issues. *giving clue about issue that Im having Having realistic reaction to client. If therapist is in room with loud aggressive client it is realistic for therapist to be afraid. * may need to address with client, or let somebody know, client is getting scary Clients feelings (anger, anxiety) are projected onto therapist If youre in a session with really depressed client, and by time session is over you feel depressed. Sometimes that happens because clients arent fully conscious of whats going on with them. Carry out emotion for person. i.e. hate friends gf because theyre mean, everyone feels upset but friend doesnt see it. -you may feel anxious because client is issue *issue I need to talk about with client in therapy To determine which type of counter transference ask yourself. . . Is client pushing my buttons?

Am I having a realistic reaction? Or is client projecting onto me? Deal with counter transference in your own therapy or seek supervision and consultation. Work out issues so it doesnt impede ability to help client. CBT- more time limited Psychotherapy- may be years and years AAMFT See handout 1.1 Basic no discrimination clause 1.2 Therapy consent form very similar to research consent form. 1.3 Multiple relationship 1.4 Ultimate relationship is to have sex with client 1.5 Sexual intimacy with former clients must wait 2 years from termination or last professional contact. 1.6 1. approach person directly and let them know its unethical. If they say that they wont do it anymore its okay. (i.e. let them know its unethical to go to lunch) 2. Go to supervisor (i.e. still going to lunch with client). Then its supervisors responsibility. (If supervisor doesnt think its a big deal and doesnt take action) If they say I cant talk about it because its confidential, document that you tried to follow up on it. 3. Go to person above them and so on and so on 4. First place afterwards you would report to BBS in California. Because thats the liscencing board responsible.- Can also report to professional organization, but the only thing they can do is kick you out of organization. Wont stop person from practicing. 5. If doing something illegal you can report to local law enforcement. If you report to licensing board, they often take care of all other avenues. If supervisor in practicum is doing something unethical you can: Talk to director or practicum supervisor at school. Work way up channels as in 1.6. 1.7- Dont use clients to further your own interests. 1.8- Clients have right to make their own decisions-autonomy code (theres no way in the world I can make that decision for you, you are the expert of your life). -Stay away from telling clients what to do because of liability- easy to sue when things go bad -More powerful when client comes up with it themselves, much more powerful to lead client to own decsions, they can take ownership of it and feel empowered. 1.9-1.11 Go together 1.9- Only continue therapy if client is benefiting. If client is not benefiting it is therapists responsibility to terminate. -If as therapist you bring up all of the areas they arent

progressing you have to bring up termination. i.e. you arent progressing maybe its not time. 1.10-Referral 1.11- reasonable arrangements for the continuation of such treatment. Also, neglect return client calls in timely fashion, or vacations. Psychodynamic-says 6 months Cognitive behavioral may say 2 weeks Need at least 4-6 weeks to work on termination (rule of thumb for Lori) -After you mention termination, you need to take therapy into context of termination. You need time to work through any issues. 1.12- ICF, for video taping, audio recording and third party observation. Should obtain a separate consent. 1.13- third party requests therapy, i.e. court mandated therapy. Find out what court needs and wants. Talk to client about whats confidential and whats not. -at school teachers or pricipals are third parties -employer also third party Must find out at outset of therapy what limits of confidentiality. i.e. attendance only, not content, etc. Principle 2- Confidentiality 2.1- Clients have right to confidentiality. Because law recognizes the need for therapy to work. Have to talk to clients about confidentiality in ICF. As well as with the limitations to client confidentiality. . . -child abuse -elder abuse -harm to self -harm to others -court cases Anything can get suppenad. A good lawyer will ask if you keep a personal journal, do you put info about your clients in journal, yes. Personal journal gets subpoenaed. 2.2- How do you deal with confidentiality within the family? i.e. if husband calls you to tell you he cheated on his wife, but tells you not to tell wife. -When youre workin with couples and families you have 3 options 1. Complete confidentiality between family members- Promising to respect confidentiality between each member. If someone in family reveals something under complete confidentiality you will not tell her. 2. There is no confidentiality between family members. Pure family systems because you are not treating individuals, you are treating the families. In order to work with them everything needs to be shared. If there are secrets thats detrimental to the system. 3. Middle Ground- Case by case basis what you tell and what you wont tell. You as therapist act as the gate keeper of the information- you retain the option of whether or not youre going to share the information. Youre going to be the judge if something is important enough that needs to be shared. Some risks involved in the third one.

*Whatever 3 option you choose it must be a part of your informed consent. My theoretical orientation is family systems I am treating you based on that. I believe that secrets are detrimental to a family. Anything you say is fair game in therapy. 2.3- Cant use client material unless client consents or if you totally unidentify the person/case so that no one could identify who it is that youre talking about. 2.4-Should keep client files in locked cabinets, if youre going to be gone for significant length of time it needs to be in confidential cabinet. -Also pertains to taking files cabinet out of file home. Should carry files in locked brief case. Youre not responsible if stolen and you took proper precautions. Even tapes, voices can be recognized. -By law you can keep records for 7 years and allowed to dispose of them (SHRED).Better to shred yourself not let any outside agency do it 2.5 Closing, move, die- procedures in place to protect clients files. Should be part of your will, in what happens to your belongings after you die. Should stipulate who is responsible for your records. Corporation- stays with them Private practice must name someone-i.e. executor of your will in case you die. 2.6Parsimony Principle- Only share amount of information that is necessary. Even if youre consulting with another therapist. -Call to consult about panic disorder, only talk about that and no other aspect of that clients life. 3.1- Competence Practice Have someone else show you Follow instructions Trial and error Same with therapy. Its a rare thing to go into something and feel completely incompetent. Cal Poly way learn by doing, thats how it is in therapy. You will make mistakes. How do supervisors know when you are competent? -Education -Training -Through supervised experience, next year and getting hours. -If you want to become therapist (i.e. sex therapist) Do process again, education, training , supervised experience. IF youre on stand and attorney asks you what makes you expert, youre answer should reflect competence. **All requirements are on BBS website 3.2 3.3- code about taking care of yourself, knowing your own limits and knowing when you need assistance. Getting into your own therapy. Thats not the only professional help you might need, substance abuse, psychiatry, doctor etc. 3.4-Conflict of interest 3.5- Recognizing all other aspects of your career. There are many roles that MFTs take. No matter what role, you still have to abide by ethical standards. 3.6- Documentation- Accurate and adequate clinical and financial records.

Insurance fraud is one of the fastest ways to get in trouble as a therapist. Another fraud-see family and bill separately -When you give someone a diagnosis it goes to the insurance and medical record. Refer Put a different disorder that is covered You could lower fee Put accurate disorder hope they pay Ask them if they want you to put more serious diagnosis 3.8 Sexual contact and sexual harassment. Inappropriate jokes, unwanted remarks and touching. Expands to any form of sexual harassment and expanding beyond just clients. 3.9 Dont exploit. Expanding to other professional roles. e.x. want to do research on client population. How do you take steps so that clients dont feel like theyre being coerced into participating - Professors wanting students to take dog for a walk or dry cleaners. Maybe okay if student offers. 3.10 Gifts Potential Risks of receiving gifts Mess up objectivity Obligated Clients might expect reciprocation Meaning behind the gift Rejection if you dont take the gift How do you say no without hurting their feelings (especially in certain cultures may be insult) Some clients may have deeper meaning, may be attracted to you make you like them more Its a good idea to at least investigate. If they bring you something really expensive say you cant accept it. There are times that you have to say no. For some clients it is a clinical issue i.e. wine under the chair when therapist said no 10/10/11 Easy for client to confuse therapeutic intimacy with sexual attraction. Your job as a therapist to learn how to set the appropriate boundaries. Danger in sleeping with client-go to jail -lose liscence -dependency, exploitation, taking advantage -very easy for client to argue that you were taking advantage -objectivity goes out of the window, not just thinking of their needs.

-Any correspondence with client Dr. Barker she puts in chart i.e. phone call write down date what it was about, holiday card, email etc. 10/12/11 - Vignettes- Clean AAMFT & CAMFT given on code. 10/24/11 AAMFT #6=CAMFT #7 - Very similar almost exactly the same CAMFT 6.1- when working or member of organization, if organization is doing something unethical you are still accountable to the profession. Make known to organization to commitment of code of ethics. -Supervisor asked her to go back and change records. Cant do that its unethical. Supervisor may say change for training purpose but once supervisor has signed off on it you cant go back and change documents. 6.2- publication gives guidelines for assigning publication credit. Give credit according to how much people have contributed to the work. Not okay to use students for work and not add them as co-author. 6.3-Faculty advisors cant take credit for their students work. If it was primarily students project, student should be first author. Should contribute beyond just advising to be author. Make sure students get credit for work they do. 6.4- Do not plagiarize. 6.5-our responsibility to make sure information is accurate. Make sure you have right to approve things before they go out. Cant say things like this persons book will save your marriage. 6.6-Probono code. Doing services for free or for very little financial gain. We as professionals have responsibility to give back. To take knowledge skill expertise to use and benefit society. -Do a workshop for free -Donate certain number of hours a week to clinic -See some clients for free or for very low cost- some people do certain percentage of practice probono -Anything you do without getting paid could be considered probono. 6.7- Parody for mental health covered at all levels similar to other health. Equal coverage in mental health as other aspects. Therapists helped pass these types of laws. -a lot of people feel that politics and therapy cant mix. Relate in terms of own values and beliefs how that might affect clients. Discourage that. If there are policies that impact mft or well being of clients we should get involved in politics. 6.8-We encourage public to participate in policing, input, what they think are needed, evaluation, encourage community to get involved in those types of things. CAMFT principle #8 responsibility to legal system8.1 Competancy to stand trial- crazy now Vs. Were they crazy at time of crime

Seeing someone court ordered to have the therapy might ask to talk in person about client. Might think you have some kind of evidence that would help the case in some way - Custody disputes. If you are treating therapist may be asked to come talk about that. 8.2- Expert witness, called in because expert in particular skill. Not related to particular client. i.e. niche is adults who were molested as children. Ask to come in just to give expert opinion on adults who were molested or children. Must base opinion in some facts, know research based on books/articles written about it. Ground answers in something concrete. High risk but can be very lucrative, charge for research time, driving time, waiting time, time on the stand. 8.3 Cant do both, be treater in family or evaluator in custody case. - If there are potential conflicts you have to let them know up front, I have your best interest at heart but because of court order I have society interest at heart as well. Let them know about confidentiality. 8.4 8.5- Impartial- Even though speaking about client or working for courts still try and be as objective as possible 8.6-Who owns the information (holder of the priveledge). For minors parent holds the priveledge. Parent gets to decide who has access to that info. Confirm holder of info, most obvious parent may be parents, foster, guardian, court if ward of the state. Sometimes kids end up with someone who isnt legal guardian, i.e grandparent or neighbor. There is a way to get around that, sign document. 8.7- only comment on people you have treated. 8.8- a custody evaluator is a particular niche. Must have proper training and credentials to do that. 8.9- Sometimes roles change i.e. seeing someone as couple then see them as individual. If role does change they need to address that up front. 8.10- custody evaluators, workers comp, court appointed mediator etc. must know related rules and regulations that govern those roles. AAMFT #7= CAMFT #9 7.1- Cant accept money or pay other people money for referrals. Can charge fee for consultation. Can charge fee for supervision, i.e. wanting to be supervised by expert in area of expertise 7.2-ICF have to talk about fees with clients up front. Fee if dont show up. How are you dealing with insurance. If get behind are you sending to collection agency. Dealt with client up front. If any changes in fee need to give plenty of notice. -sister. Deductable changed owed 500 dollars, refused service didnt give notice of pay. 7.3- Give notices, after 3rd notice is if I dont get this by such and such date its going to collections. Must be outlined in ICF. Only give enough information to collect fees 7.4-make sure information is given is acuarte. If seeing as family avoid charging for multiple sessions when it was only one session. Insurance Fraud!

7.5 Bartering may be done only if client requests, relationship not exploitive, clear contract. i.e. four sessions= X amount of work on car. Onus on therapist to prove its not exploitive relationship. Code saying try not to do it. 7.6- Cant refuse to release records just because they didnt pay. If sent to collections but client comes back with past due bills-if you cant help must refer, but you should help if in immediate crisis. AAMFT 8=CAMFT 10- Advertising Theme to remember honesty and accuracy 8.1- in advertising have to be accurate, truthful honest 8.2- Any information needed for public to make appropriate selection of your services. Contact info, school licensing, degrees, expertise. Must be accurate. Can earn different certificates and list those i.e. certified EMDR therapist 8.3-i.e. dont put on business card Dr. Phil big and last name small. To mislead public about who you are. 8.4-business considered advertising, website letterhead etc. 8.5-In regards to education, be honest be accurate just list those things that are legitimate 8.6 Responsible even for what other people say about us. Speaker who introduces says something that is not correct, i.e. went to Pomona college not CPP your job to correct. Or say you have certification when in process and dont have. Our job to correct information. 8.7-Make sure everybody you work with represents themselves accurately. 8.8-Dont say specialized service if you dont have proper training etc. Cant guarantee anything in therapy. Not accurate info about exactly what it costs. Doesnt say what qualifies as an expert. Steps to ethical dec making Virtue ethics etc. Main ideas and concepts in each chapter. More than a page. Study over sample quizzes No clear cut right or wrong answers on test. Tell from codes what youre basing decision on and how youre justifying how you would handle it. Cant use both AAMFT and CAMFT in same question Whar are legal and ethical issues, ICF second-how would you handle it. Refer out ethically: Work with someone who is able to help them with their issue. If in public and see client -hide -intake ask them how they would want you to act -Issue, confidentiality. You dont want to breach confidentiality.

Generic standard discussion, if I run into you in public I will not speak to you first to protect confidentiality. I will leave that decision up to you. **TRANSFERENCE-test Get permission to do therapy outside of office. Sign release. Talk about pros and cons.