Ethics - Trudy Gilbert


Published on

Published in: Business, Technology
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • NRS641A.060
  • Obtain supervision to work with the seven year old
    Refer the family to a competent therapist who specializes in younger children.
  • NRS 641A.310 and .313
  • NRS641A.320
    Can reapply for license one year after revocation.
  • NAC641A.220
  • Ideas: weekly consultation, monitor work, modify work day/week to ensure she is working at optimal levels.
  • NAC641A.243
  • 1.
  • The therapist should disclose what they know so the client can make an informed decision to make subsequent sessions.
  • Cannot reveal that the client is in psychotherapy with him.
    Consult with a colleague
    If Therapeutic objectivity/effectiveness becomes compromised then must explain to patient, provide a referral, assist in the transition to a new provider.
  • Meet with the supervisee. Disclose the review.
    Let the supervisee know there is a protocol for the use of different therapies within supervision.
    Lets say the secondary supervisor is trained in this type of therapy, what do you do next?
  • NAC641A.256
  • NAC641A.252
  • Address issues secondary to safety, etc. (how are they getting home?)
    Make another appointment to discuss fees and consents when they are sober.
  • prior to commencing compliant with all relevant laws for the delivery of such services and must 1. determine that the electronic therapy is appropriate for clients, re: their intellectual, emotional, and physical needs, 2. inform clients of the potential risks and benefits associated with electronic therapy 3. ensure the security of the communication medium 4. only commence electronic therapy after appropriate education, training, or supervised experience using the relevant technology.
    **Sign separate consent, make sure you have a privacy statement and utilize privacy rules such as pass-word protection and SHARE THESE WITH THE CLIENT! They should be doing the same with their information especially if its email, etc.
    Make sure you check in with the insurance company to make sure you can continue to bill. Get this assurance in writing and bill it properly.
    and always 1. stay abreast of advances in the field, 2. require in-person initial consultation 3. indentify professionals in their immediate area that can be called in in the event of a crisis.
  • No, it is considered a ‘casual admission’ and is not part of informed consent.
  • Obtained consent in writing including for which purposes the therapist would disclose and how much detail.
    OR, disguised better: the dream should have been changed in ways to make it impossible to connect it to the patient.
  • Obtain supervision—even informally
    Consider going in to therapy from a professional standpoint to continuously look at countertransference issues.
  • Must report on ACTUAL performance and observed behavior.
  • Yes, he can so long as he sets it up as time-limited, that there is a contract specifying the equivalent monetary value of the services. This is ethically permissible because the barter did not directly affect his therapeutic relationships with the children or the parents or teacher whom he worked with, not exploitative barter arrangement and showed respect for the continuation of services under adverse circumstances.
  • Call editor
    Follow up with a letter to the editor that she requested the website change and cc: to the university.
  • 1 progress notes
    2 case notes
    3. Consultation notes
  • According the NV State law, the 16 year old with a child can sign her own consent to treatment. Know the laws.
  • Report to the police
    Give ONLY the amount of information necessary to make the report
    Yes, she has the ability to terminate the relationship.
  • To understand the court order and what is expected.
    To fully disclose to the client the extent of their obligation to reveal information to the court which might be used to rescind parole.
  • Ethics - Trudy Gilbert

    1. 1. Ethics Presented by: Trudy Gilbert-Eliot, M.S., LMFT, LADC
    2. 2. Overview  State Law  State Regulations  AAMFT Ethics Code  *Understanding Ethics  Ethical Decision-making
    3. 3. Understanding Ethics  Handout
    4. 4. Law and Ethics  Nevada Revised Statutes (NRS) 641A  Nevada Administrative Code (NAC) 641A  American Association of Marriage and Family Therapists (AAMFT) Code of Ethics  Case Law
    5. 5. Definition  “Marriage and family therapist” means a person who describes himself or herself or his or her services to the public by any title or description which incorporates the term “marriage and family therapist” or “marriage and family counselor”  “Practice of marriage and family therapy” means the diagnosis and treatment of mental and emotional disorders, whether cognitive, affective or behavioral, within the context of interpersonal relationships…. services to a person, couple, family or family group or other group of persons.  Limitations: diagnosis/treatment of a psychotic disorder, and assessments of intelligence, personality, aptitude, interests or addictions.
    6. 6. Understanding Ethics  A therapist with experience working with adolescents received a call from a family wanting him to work with their seven-year-old son. What should he tell the family?
    7. 7. Grounds for Denial, Suspension, or Revocation          Conviction of felony Habitual drunkenness or addiction Impersonation Using fraud or deception in obtaining license or taking/passing exam Rendering or offering to render services outside of area of training, experience, or competence Committing unethical practices Unprofessional conduct as determined by the Board Operation of a medical facility when the license is suspended or revoked Failure to pay child support
    8. 8. Discipline  Probation  Suspending license for not more than a year  Revoking license  Public reprimand  Limiting practice  Fine not more than $5000.00  Complete another examination
    9. 9. Requirements  Age 21 or more  Good moral character  Citizen of US or entitled to work in US  Education approved by Board  Two years postgraduate experience in MFT  3000 hours supervised experience of which 1500 is direct contact with clients  Undergraduate degree from accredited institution approved by Board
    10. 10. Understanding Ethics  A therapist had just gone through treatment for cancer and was returning to work after a sabbatical. She believed she was fully recovered from the chemotherapy, including symptoms of extreme fatigue and mental deficits, but isn’t quite sure. What would you tell your colleague if she came to you for feedback?
    11. 11. Professional Responsibility  Advertising  Impairment  Relationship Exploitation  Boundaries  Giving/receiving fees  Consultation  Disparaging colleagues  Scope of practice
    12. 12. Understanding Ethics  A client tells you that they were in therapy four years ago and had a sexual relationship with the therapist. What do you do?
    13. 13. Understanding Ethics, Redux  You share an office with three colleagues and frequently notice the comings and goings of their clients, as they do yours. One day you are at Starbucks to meet a friend for coffee and you notice one of your colleagues with a current client. He leans over and kisses her. What do you do?
    14. 14. Professional Responsibility, Cont.  Reporting  Practice base  Current knowledge  Record keeping  Records to the court  Supervision/supervisee  Board notification
    15. 15. Understanding Ethics  A therapist had been working with XYZ insurance company and frequently experienced problems with them giving accurate benefits/coverage information. A new client attends their first appointment and the therapist found that they had XYZ insurance as their primary carrier. What should the therapist do?
    16. 16. Responsibility to Clients/Others Professionalism and Competence Safeguard the interests of incompetent client Deal with legal representatives of clients Non-discrimination Cannot misrepresent efficacy/results of services  Apprise of rights, risks, financial obligations  Consultation  Termination     
    17. 17. Understanding Ethics  A therapist in private practice noticed that one of his neighbors had begun to date one of his clients. What should he do?
    18. 18. Responsibility to Clients/Others, Cont.  Withdrawing services  Termination/Interruption of services  Influence  Personal/sexual relationships  Dual relationships
    19. 19. Understanding Ethics  You have an intern and regularly observe or watch video-tapes of sessions. In a recent review you watch a video of your intern performing a type of therapy that is not listed on their training outline and is not one that you have any experience with. What do you do?
    20. 20. Unprofessional Conduct  Intern: Performs services outside the scope of internship plan  Performing therapy with a lapsed license  Failing to cooperate with an investigation  Gross negligence  Malpractice
    21. 21. Code of Ethics  AAMFT Code of Ethics utilized “as a standard for professional conduct in the State of Nevada”
    22. 22. Understanding Ethics  A client attends his first session clearly under the influence of alcohol. Normally the therapist goes through the consents in the first session. What should this clinician do?
    23. 23. AAMFT Code of Ethics: Responsibility to Clients  Non-Discrimination  Informed Consent  Multiple Relationships  Sexual Intimacy with Current Clients and Others  Reports of Unethical Conduct  No Furthering of Own Interests  Client Autonomy in Decision-Making
    24. 24. Understanding Ethics  You have a client you have been seeing for some time who is moving to a rural area of Nevada. They want to keep ‘seeing’ you as a therapist and suggests you set up a way to have sessions via Skype. What are your obligations?
    25. 25. AAMFT Code of Ethics: Responsibility to Clients, Cont.  Relationship Beneficial to Client  Referrals  Non-Abandonment  Written Consent to Record  Relationships with Third Parties  Electronic Therapy
    26. 26. Understanding Ethics  During a break in a court-ordered evaluation for a client’s inclusion in a domestic battery group, the therapist hears the man brag to others he knows in the waiting room about the crime and that he is selling drugs. Can the therapist include this in the report to the court?
    27. 27. Understanding Ethics  A therapist gives a speech to a group of colleagues and includes a case example with occupation, family constellation, city of residence, while other patient demographics were disguised. The therapist shares a dream the client had and someone in the audience was able to identify the patient because they had described this dream to them, as well. What should this therapist have done instead?
    28. 28. AAMFT Code of Ethics: Confidentiality  Disclosing Limits of Confidentiality  Written Authorization to Release Client Information  Confidentiality in Non-Clinical Activities  Protection of Records  Preparation for Practice Changes  Confidentiality in Consultations  Protection of Electronic Information
    29. 29. Understanding Ethics  A therapist came home early one day to find her husband in bed with her best friend. A large portion of her practice was conducting couples therapy. She comes to you as a colleague devastated and wants to know what she should do about her work. What would you tell her?
    30. 30. AAMFT Code of Ethics: Professional Competence and Integrity  Maintenance of Competency  Knowledge of Regulatory Standards  Seek Assistance  Conflict of Interest  Veracity of Scholarship  Maintenance of Records  Development of new Skills
    31. 31. Understanding Ethics  An adolescent client had been in therapy and was preparing for termination after a very successful therapy experience. During the second to last session she brings you a handmade necklace. Since therapists are discouraged from receiving gifts, what do you say? What if she was from a wealthy family and the necklace was clearly very expensive?
    32. 32. AAMFT Code of Ethics: Professional Competence and Integrity, Cont. Harassment Exploitation Gifts Scope of Competence Accurate Presentation of Findings Public Statements Separation of Custody Evaluation form Therapy  Professional Misconduct       
    33. 33. Understanding Ethics  A therapist/supervisor was having a casual conversation with a colleague who revealed one of her supervisees had made several very harsh, racial comments at a recent professional lunch. In supervision there had never been any indication that the supervisee held racially-biased opinions. When reporting to the Board at the 6-month review, do you report this information? What would you do?
    34. 34. AAMFT Code of Ethics: Responsibility to Students and Supervisees  Exploitation  Therapy with Students or Supervisees  Sexual Intimacy with Students or Supervisees  Oversight of Supervisee Competence  Oversight of Supervisee Professionalism  Existing Relationship with Students or Supervisees  Confidentiality with Supervisees
    35. 35. AAMFT Code of Ethics: Responsibility to Research Participants  Protection of Research Participants  Informed Consent  Right to Decline or Withdraw Participation  Confidentiality of Research Data
    36. 36. Understanding Ethics  You work for ABC agency. A couple comes in for couples counseling to deal with the conflicts that have come up in their relationship due to their daughter who is bipolar. The couple does not have couples therapy coverage with their insurance. The clinic director says to bill it as individual therapy for the child. What do you do?
    37. 37. AAMFT Code of Ethics: Responsibility to the Profession  Conflicts Between Code and Organizational Policies  Publication Authorship  Authorship of Student Work  Plagiarism  Accuracy in Publication and Advertising  Pro Bono  Advocacy  Public Participation
    38. 38. Understanding Ethics  A therapist worked a part-time job in a rural community conducting school-based counseling for children acting out at school. The community suffered some economic consequences that precluded them from financially paying the therapist so they offered him room, board, office space and travel reimbursement. Should the therapist agree?
    39. 39. AAMFT Code of Ethics: Financial Arrangements  Financial Integrity  Disclosure of Financial Policies  Notice of Payment Recovery Procedures  Truthful Representation of Services  Bartering  Withholding Records for Non-Payment
    40. 40. Understanding Ethics  When reviewing a publishing Website that was advertising her very first book, a therapist realized that they claimed that she was a professor of psychology at a university that she had taught at several years before as an adjunct professor. What should she do?
    41. 41. AAMFT Code of Ethics: Advertising  Accurate Professional Representation  Promotional Materials  Professional Affiliations  Professional Identification  Educational Credentials  Correction of Misinformation  Employee or Supervisee Qualifications  Specialization
    42. 42. Understanding Ethics  A therapist is has some questions about the treatment of a very contentious couple who are threatening divorce every session. She is concerned about her objectivity and interventions since the way they fight reminds her of her first marriage when she was 20. She took some notes to herself and wonders if she should seek consultation with a colleague. What are her obligations in regards to record keeping?
    43. 43. Other Ethical Issues  Domestic Violence—Child Abuse  Emotional Abuse of Children  Financial Abuse of Elders  Guilty and No Contest pleas  HIPAA  Immunity from Liability  Joint Legal Custody  Record Keeping
    44. 44. Understanding Ethics  A 16-year-old mother who is receiving State Medicaid makes an appointment to see you for help adjusting to parenting and dealing with friends who have rejected her because she kept her baby. She continues to live with her parents who are very religious and do not believe in therapy. Who signs the consent forms?
    45. 45. Other Ethical Issues, Cont.  Leaving an Agency  Treating minors without Parental Consent  Online therapy  Privilege  Billing Practices: Self and Interns  Service of a Subpoena  Termination  Renewing license and Malpractice
    46. 46. Understanding Ethics  A client leaves a series of voicemails that articulate a desire to hurt the therapist and the front office personnel. What are the therapists confidentiality obligations? What should she do? Can she terminate the therapeutic relationship?
    47. 47. Other Ethical Issues, Cont.  Hypnosis and Crime Victims  CEU’s  Violence against Therapist and Confidentiality  Suicide and Confidentiality  Experimental Therapies  Referrals  Abuse in other States
    48. 48. Understanding Ethics  A judge ordered a convicted sex-offender to receive weekly therapy. What obligations does the therapist have to the court? What obligations does the therapist have to the client?
    49. 49. Ethical Decision Making (Fisher, 2003)  Step 1: Professional commitment  Step 2: Be familiar with the ethics code  Step 3: Gather facts  Step 4: Understand stakeholders’ perspectives  Step 5: Apply 1-4 to generate ethical alternatives  Step 6: Select and implement and ethical course of action.
    50. 50. Contact Information  Trudy Gilbert-Eliot, M.S., LMFT, LADC  Nevada Marriage and Family Therapist #0828  Nevada Licensed Alcohol and Drug Counselor #0127L  458 Court Street  Reno, NV 89501  775-772-9017 