New Jersey LPC Ethical/Legal Issues in Clinical Supervision

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Ethical and Legal Considerations
in Clinical Supervision
Glenn Duncan LPC, LCADC, CCS,
ACS

Why have legal and ethical standards?
One of the main purposes of the courts
is to determine innocence or guilt.
One of the main purposes of Federal
and State laws and statutes, licensure
regulations, professional standards,
and sound personal judgment is
to keep you out of court.

Are YOU Qualified!?
What does it take to supervise a given license in
the state of NJ?
Professionals Seeking – Licensed Clinical Social Worker (LCSW)
 Beginning on July 7, 2004, clinical supervision shall be rendered by a
LCSW with a minimum of three years of licensure (1,500 hours counts as
one year) as a LCSW and who has completed at least 20 continuing
education credits of post-graduate course-work related to supervision. Any
LSW who has entered into a supervisory relationship with a supervisor
pursuant to (a)2 above may continue the supervisory relationship until July
7, 2007.
 A person with an LSW AND LCADC is NOT QUALIFIED TO SUPERVISE A
CADC or CADC Intern according to the Social Work Licensing Board.

Are YOU Qualified!?
People seeking - Licensed Professional Counselor (LPC)
 “Qualified Supervisor” an individual who holds a clinical license to provide mental
health counseling services for a minimum of two years (obtaining at least 3,000 hours
work experience subsequent to holding the license in a minimum of 2 years but no
more than 6 years) in the state where the services are being provided, and who has:
1. A clinical supervisor’s certificate from the National Board for Certified
Counselors Center for Credentialing and Education or its successor, or the
American Association of Marriage and Family Therapy or its successor.
2. On or after October 5, 2011 shall hold an approved clinical supervisor credential
from the Center for Credentialing and Education of the NBCC or an equivalent
clinical supervisor credential recognized by individual’s respective healthcare
licensing board.
3. Completed a minimum of three graduate credits in clinical supervision from a
regionally accredited institution of higher education.

Are YOU Qualified!?
People seeking - Licensed Marriage and Family Therapist (LMFT)
 “Qualified Supervisor” means an individual who has no less than 5 full-time years of
professional marriage and family therapy practice experience or the equivalent and has
either:
1. A NJ license to practice as a marriage and family therapist; or
2. Obtained from an accredited institution a minimum of:
i. A master’s degree in marriage and family therapy;
ii. A master’s degree in social work;
iii. A graduate degree in a related field and has demonstrated to the Board that
he/she has completed course work content and training substantially
equivalent to a master’s degree in marriage and family therapy; or
iv. A graduate degree in a related field which does not provide training and course
work substantially equivalent in content to a master’s in marriage and family
therapy , and is either a post graduate degree recognized by the Board , or a
program of training and course work at an institute or training program
accredited by the Commission on Accreditation for Marriage and Family
Therapy Education.

Are YOU Qualified!?
People seeking - Licensed Clinical Alcohol and Drug Counselor
(LCADC) or Certified Alcohol and Drug Counselor (CADC)
1. A New Jersey licensed clinical alcohol and drug counselor;
2. A New Jersey licensed physician certified by the American Society of
Addiction Medicine (ASAM) or a psychiatrist with added qualifications in
chemical dependency from the American Psychiatric Association; and
3. A New Jersey certified advanced practice nurse, licensed psychologist,
licensed clinical social worker, licensed marriage and family therapist or
licensed professional counselor all of whom shall be certified as clinical
supervisors by ICRC member boards.

Major Legal Issues For Clinical
Supervisors
Malpractice
 Harm to another individual due to negligence consisting of the
breach of a professional duty or standard of care.
 When you take the role of supervisor, you are expected to know
and follow the law, as well as the profession’s ethical standards.

Increase in Lawsuits?
 A general decline in the respect afforded helping professionals by
clients and society at large.
 Increased awareness of consumer rights in general.
 Highly publicized malpractice suits where settlements were
enormous, leading to the conclusion that a lawsuit may be a means
to obtain easy money.

What is needed to prove Malpractice?
 A professional relationship with the therapist (or supervisor) must
have been established.
 The therapist’s (or supervisor’s) conduct must have been improper
or negligent and have fallen below the acceptable standard of care.
 The client (or supervisee) must have suffered harm or injury, which
must be demonstrated.
 A causal relationship must be established between the injury and
the negligence or improper conduct.

How to Reduce Legal Liability
 One of the most important things a supervisor can do to reduce the
risk of a charge of negligence is to screen prospective employees
carefully.
 In addition to information on academic credentials and work
experience, it is important to know if their present skill level is
consistent with the expectations of the supervisor.
 Supervisors scrupulously should follow the regulations of their
respective accrediting board (e.g., Psychologists, Social Workers,
CADCs) regarding supervision.
 They should check with their malpractice carrier to be certain that
their supervisory functions are covered. It also may be prudent to
require the supervisee to carry his or her own professional liability
insurance.

How to Reduce Legal Liability
 Supervisors should take whatever actions are necessary to ensure the
quality of services delivered to the patient.
 The extent of the monitoring will depend on several factors, including the
skill level of the supervisee, the type of services being performed, and the
direct knowledge of the supervisor of the skill of the supervisee.
 As noted above, the minimal supervisory requirements for clinicians-in-
training are more specific than those for other unlicensed employees.
 Supervisors would be liable if they assigned a patient to a supervisee
who did not have the skill level to provide adequate services.
 Finally, supervisors must document all supervisory sessions in a manner
consistent with established record-keeping rules and requirements.

The Duty to Warn and Protect
 Case Name: Vitaly TARASOFF v. REGENTS OF UNIV OF CA.,
et. al. Date, Location, Cite: 1976 CA. 131 Cal Rptr 14, 551 p2d
334.
 CA Supreme Court: Prosenjit Poddar told student health he
wanted to kill Tatiana Tarasoff. Psychologist told supervising
psychiatrist, who told campus police, who checked & let Poddar
go.
 Poddar killed Tatiana. Parents sued for "failure to warn"- Trial
Court said no duty existed, but CA Supreme Court cited
Simenson v Swensen, ordered trial; heard twice, settled out:
 “Tarasoff #1” -"Privilege ends where public peril begins."
“Tarasoff #2” - Therapist has an obligation to use reasonable
care to protect potential victim.
 SUPER LAND MARK - created whole new cause for action, but
based on Simenson v Swensen because settled out of court.

The Duty to Warn and Protect
 1975 “Tarasoff #1” -"Privilege ends where public peril begins."
1976 “Tarasoff #2” - "When a therapist determines, or pursuant
to the standards of his profession should determine, that his [client]
presents a serious danger of violence to another, he incurs an
obligation to use reasonable care to protect the intended victim
against such danger. The discharge of this duty may require the
therapist to take one or more various steps, depending upon the
nature of the case. Thus it may call for him to warn the intended
victim or others likely to apprise the victim of the danger, to notify
the police, or to take whatever other steps are reasonably
necessary under the circumstances."
 SUPER LAND MARK - created whole new cause for action, but
based on Simenson v Swensen because settled out of court.

New Jersey Duty to Warn & Protect Law
 N.J. Stat. 2A:62A-16 Medical or counseling practitioners' immunity from civil liability
 a. Any person who is licensed in the State of New Jersey to practice psychology,
psychiatry, medicine, nursing, clinical social work or marriage counseling, whether
or not compensation is received or expected, is immune from any civil liability for a
patient's violent act against another person or against himself unless the practitioner
has incurred a duty to warn and protect the potential victim as set forth in
subsection b. of this section and fails to discharge that duty as set forth in
subsection c. of this section.
 b. A duty to warn and protect is incurred when the following conditions exist:
 (1) The patient has communicated to that practitioner a threat of imminent, serious
physical violence against a readily identifiable individual or against himself and the
circumstances are such that a reasonable professional in the practitioner's area of
expertise would believe the patient intended to carry out the threat; or

 N.J. Stat. 2A:62A-16 Medical or counseling practitioners' immunity from civil
liability (continued)
 (2) The circumstances are such that a reasonable professional in the
practitioner's area of expertise would believe the patient intended to carry out an
act of imminent, serious physical violence against a readily identifiable individual
or against himself.
 c. A licensed practitioner of psychology, psychiatry, medicine, nursing, clinical
social work or marriage counseling shall discharge the duty to warn and protect
as set forth in subsection b. of this section by doing any one or more of the
following:
 (1) Arranging for the patient to be admitted voluntarily to a psychiatric unit of a
general hospital, a short-term care facility, a special psychiatric hospital or a
psychiatric facility, under the provisions of P.L.1987, c.116
 (C.30:4-27.1 et seq.);

 N.J. Stat. 2A:62A-16 Medical or counseling practitioners' immunity from civil liability
(continued)
 (2) Initiating procedures for involuntary commitment of the patient to a short-term
care facility, a special psychiatric hospital or a psychiatric facility, under the provisions
of P.L.1987, c.116 (C.30:4-27.1 et seq.);
 (3) Advising a local law enforcement authority of the patient's threat and the identity of
the intended victim;
 (4) Warning the intended victim of the threat, or, in the case of an intended victim who
is under the age of 18, warning the parent or guardian of the intended victim; or
 (5) If the patient is under the age of 18 and threatens to commit suicide or bodily
injury upon himself, warning the parent or guardian of the patient.
 d. A practitioner who is licensed in the State of New Jersey to practice psychology,
psychiatry, medicine, nursing, clinical social work or marriage counseling who, in
complying with subsection c. of this section, discloses a privileged communication, is
immune from civil liability in regard to that disclosure.

 N.J. Stat. 2A:62A-17 Court order required for certain disclosures
 When a duty to warn and protect arises from the receipt of a privileged
communication from a patient in a drug or alcohol abuse program governed
by federal law, a licensed practitioner of psychology, psychiatry, medicine,
nursing, clinical social work or marriage counseling may be required to
obtain a court order authorizing disclosure prior to disclosure of information
about the patient including the patient's threat of violence, in accordance
with 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 and regulations
promulgated thereunder. *
 See also: McIntosh v. Milano, 168 NJS 466 (Law Div. 1979)
 * The regulations are the federal Confidentiality of Alcohol and Drug Abuse
Patient Records; Final Rule, 42 CFR Part 2

42-CFR-Part 2 – Exceptions to
Confidentiality
 § 2.22 Notice to patients of Federal confidentiality requirements.
 The confidentiality of alcohol and drug abuse patient records maintained by this program is
protected by Federal law and regulations. Generally, the program may not say to a person
outside the program that a patient attends the program, or disclose any information
identifying a patient as an alcohol or drug abuser Unless:
 (1) The patient consents in writing:
(2) The disclosure is allowed by a court order; or
(3) The disclosure is made to medical personnel in a medical emergency or to qualified
personnel for research, audit, or program evaluation.
 Violation of the Federal law and regulations by a program is a crime. Suspected violations
may be reported to appropriate authorities in accordance with Federal regulations.
 Violation of the Federal law and regulations by a program is a crime. Suspected violations
may be reported to appropriate authorities in accordance with Federal regulations. Federal
law and regulations do not protect any information about a crime committed by a patient
either at the program or against any person who works for the program or about any threat
to commit such a crime. Federal laws and regulations do not protect any information about
suspected child abuse or neglect from being reported under State law to appropriate State
or local authorities.

Confidentiality
 § 2.22 Notice to patients of Federal confidentiality
requirements.
 Federal law and regulations do not protect any information about a crime
committed by a patient either at the program or against any person who
works for the program or about any threat to commit such a crime. Federal
laws and regulations do not protect any information about suspected child
abuse or neglect from being reported under State law to appropriate State
or local authorities.
 § 2.14 Minor patients (d)(2) The applicant's situation poses a
substantial threat to the life or physical well being of the applicant or any
other individual which may be reduced by communicating relevant facts to
the minor's parent, guardian, or other person authorized under State law to
act in the minor's behalf.

Confidentiality
 § 2.63 Confidential communications.
 (a) A court order under these regulations may authorize disclosure of
confidential communications made by a patient to a program in the course
of diagnosis, treatment, or referral for treatment only if:
 (1) The disclosure is necessary to protect against an existing threat to life or
of serious bodily injury, including circumstances which constitute suspected
child abuse and neglect and verbal threats against third parties;
 (2) The disclosure is necessary in connection with investigation or
prosecution of an extremely serious crime, such as one which directly
threatens loss of life or serious bodily injury, including homicide, rape,
kidnapping, armed robbery, assault with a deadly weapon, or child abuse
and neglect; or
 (3) The disclosure is in connection with litigation or an administrative
proceeding in which the patient offers testimony or other evidence
pertaining to the content of the confidential communications.

Imminent Danger Defined
Imminent danger is a concept used to describe problems that can
lead to dire consequences for the client (and others). Imminent
danger is defined as the following 3 components:
1. A strong probability that certain behaviors (such as continued
alcohol or drug use or continued self harm) will occur.
2. The potential for such behaviors to present a significant risk of
serious adverse consequences to the individual and/or others.
3. The likelihood that such harmful events will occur in the near future.

NBCC Code of Ethics: Duty to Warn
 When a client’s condition indicates that there is a clear and
imminent danger to the client or others, the certified counselor must
take reasonable action to inform potential victims and/or inform
responsible authorities.
 Consultation with other professionals must be used when possible.
 The assumption of responsibility for the client’s behavior must be
taken only after careful deliberation, and the client must be involved
in the resumption of responsibility as quickly as possible.

The Duty to Warn
 Was their supervisor issues in this case?
 What relevance did supervision have on the case?
 It is imperative for supervisors to inform supervisees of conditions under
which it would be appropriate to implement the duty to inform an intended
victim.
 The clinical supervisor was implicated in the finding of a negligent failure to
warn the prospective victim. If the supervisor had examined Poddar and
found him to not be dangerous, the grounds for liability based on
foreseeability would have been less clear.
 The expectation is that sound clinical judgment and reasonable or due care
are taken regarding the determination of dangerousness.

Duty to Warn Vignette
Paul is referred to your organization for domestic violence. The domestic violence was
towards a girlfriend who was attempting to break up with him. Paul and the girlfriend
have since broken up, and she has a restraining order against him (which he states he
abides by). Both clinicians with experience with this type of client are full and cannot
accept any addtional clients. As the clinical director you decide to give this case to an
intern, who is supervised by one of your master’s level clinicians. The intern is assigned
the case and not much happens for a few months that you are aware of. One week in
supervision, your clinician comes to you to inform you that a situation has happened with
this client.
You come to find out that Paul has been increasingly making threatening statements
towards other drivers on the road when he travels to work. He describes how he gets
“infuriated” by other drivers who cut him off, or don’t move out of the fast lane when he is
behind them. At first “altercations” were just gestures back and forth between he and the
other driver at the time. However, in the past week he followed another driver all the way
to that person’s job, and proceeded to fight him in the parking lot.

Duty to Warn Vignette
When asked if anybody was hurt, Paul replied that the other person was “a bit
bloody” when Paul left him on the parking lot grounds. Paul confided to the intern that
he has now started carrying a gun in the car. He at first played with the intern by
stating the gun was there for his “protection”, but later hinted that it might “come in
handy” on his way to work. When pressed, Paul stated that he would only wave the
gun at a potential “highway offender” to scare him/her. He also stated he is licensed
to carry the gun, and the gun is loaded. The final piece of information that the
clinician tells you is the nature of the domestic violence towards the ex-girlfriend was
Paul hitting this woman on the face with the barrel of a gun.
Paul has been diagnosed with Intermittent Explosive Disorder (DSM-5 F63.81). Paul
is employed full-time at Home Depot and works as the customer service manager for
returns. Basically his job consists of being the returns and complaints manager at
the Home Depot.

Duty to Warn Vignette Questions
 What are your obligations, if any? If you find you have obligations,
who are you obliged to warn? (There are 3 different
groups/individuals you need to discuss). Do you have imminent
danger with Paul in regards to any of these groups/individuals?
1. Currently the only form of feedback on this case comes from self-
report of the intern to the clinician supervising the intern. Is this
sufficient?
2. Were there any problems in the supervisory process that was
described in this example?

Duty to Warn Vignette 2 – “Man found
guilty of serial HIV assaults”
From CNN.com, 11/09/2004
OLYMPIA, Washington (AP) -- A
man was convicted by a judge
Monday on charges he deliberately
exposed 17 women to HIV by having
unprotected sex with them. Five of
the women have tested positive for
the virus, which causes AIDS.
Anthony E. Whitfield, 32, faces a
minimum sentence of 137 years in
prison on the 17 counts of first-degree
assault with sexual motivation and
other charges.
Health officials said as many as 170
people may have been exposed to the
virus because of Whitfield's actions,
counting subsequent partners of
women he slept with. No additional
people have tested positive for HIV,
but 45 refused to be tested or couldn't
be found.
During the trial in Thurston County
court, an Oklahoma prison official
testified that Whitfield was diagnosed
with HIV while incarcerated in 1992.
Two women testified that Whitfield
once said, seemingly in jest, that if he
had HIV, he would give it to as many
people as he could.
Defense lawyer Charles Lane said
Whitfield was addicted to
methamphetamine and used women
for shelter, money and sex but never
meant to inflict "great bodily harm" as
required for him to be convicted of
first-degree assault.
February 22nd
, 2010 – R.D.W. of
Alexandria, NJ charged with
knowingly spreading HIV. This is a
3rd
degree diseased-person charge
(reserved for HIV or AIDS), 4th
degree is for gonorrhea/syphilis.
Anthony E. Whitfield, right,
is handcuffed by a Thurston
County corrections officer
Monday.
http://www.cnn.com/2004/LAW/11/09/hiv.assault.ap/index.html
http://www.lehighvalleylive.com/hunterdon-county/express-

2012 NJ Court Ruling
 Addressing uncharted legal waters in New Jersey, a state judge ruled that state
agencies have no duty to notify a person of their partner's HIV/AIDS status when the
infected person is a patient or client of the agency, according to an opinion published
Friday.
 Superior Court Judge Vincent LeBlon, in Middlesex County, refused to reinstate a
lawsuit alleging the Newark Community Health Center, the state Department of
Health and Senior Services and others violated their duty by failing to disclose the
HIV status of woman's longtime boyfriend, named in the suit as “D.D.”
 He said laws protecting the confidentiality of HIV/AIDS patients forbid the disclosure
of such information to all but qualified personnel unless the patient has given prior
written consent.

2012 NJ Court Ruling
 “Therefore, not only did defendants have no duty to disclose D.D.'s HIV status to
plaintiff, but they were actually prohibited from doing so by New Jersey law,” the
judge ruled in a case of first impression.
 NJ allows the plaintiff to have a cause of action against D.D. for negligently exposing
plaintiff to HIV, but that law does not require an extension of this duty to report to
agencies bound by the HIV/AIDS confidentiality laws of New Jersey.
 http://www.law360.com/articles/362447/agencies-have-no-duty-to-warn-partners-of-
aids-risk-judge

HIV Reporting
 As of 2009, 28 states (including NJ) now have HIV reporting for both adults and
adolescents. Under great security, NJ stores names and addresses of individuals
who are infected with the virus that causes AIDS.
 Residents have the option of learning their HIV status without their names being
reported (by being tested anonymously), if they go to 1 of 15 state-financed HIV
testing and counseling sites. The approximately 200 residents per year who choose
this option are identified by a number, and the state receives only demographic
information like age, sex and race.
 New Jersey’s system of notifying partners is voluntary. Spouses or other partners of
infected people are not notified without the consent of the infected person.
 A person with HIV or AIDS who knowingly infects another (which in NJ law the other
person has to be unaware that their partner was infected), is given a 3rd
“degree
diseased person” charge. A lesser 4th
degree charge is reserved for sexually
transmitted diseases other than HIV or AIDS.
2009 – Leadership Seminar: “Guide to Mental Health Law in NJ and PA.” Leadership Seminars, 4020 N. MacAuthor Blvd, Ste. 122, Irving, Tx. (800) 443-6912.

Direct and Vicarious Liability
Simmons vs. United States (1986)
o A client was encouraged by a therapist to have sexual relations with
him as a means of acting on her transference feelings and
ultimately attempted suicide. The court found both the therapist and
his supervisor negligent. The supervisor should have known about
the “negligent acts of a subordinate” as there was reason to suspect
something inappropriate was taking place.

Direct and Vicarious Liability
 Direct Liability: When the actions of the supervisor were
themselves the cause of harm.
If the supervisor did not perform supervision adequate for a
clinician.
If the supervisor suggested (and documented) an
intervention that was determined to be the cause of harm.
 Vicarious Liability: Being held liable for the actions of the supervisee
when these [actions] were not suggested or even known by the
supervisor.
“The supervisor is generally only held liable for the negligent acts of
supervisees if these acts are performed in the course and scope of
the supervisory relationship” (Disney & Stephens, 1994).

Vicarious Liability (Continued)
“The psychotherapy supervisor assumes, in general, clinical
responsibility much as if the patient were under his or her own care”
(Slovenko, 1980).
 Failure to properly oversee the functioning of the clinician is one of
the highest liability issues. How does one best demonstrate
supervisory involvement and prevent malpractice suits:
1. Documentation: supervisor should maintain personal
records of dates and times when supervision was provided.
(Client Name? Clinical Area Covered? Supervisee Issues Only?
Writings should be brief in nature.)
2. Consultation: Regularly scheduled supervision, offering careful
assessment, oversight of clinicians, and regular evaluation.
3. It is advisable for the supervisor to make an independent
assessment of severely disturbed or dangerous clients.

Vicarious Liability (Continued)
Vicarious Liability was part of the legal argument in the Tarasoff vs.
Regents of California case.
 In that case, the lawyer for the plaintiff argued that if the supervisor
independently assessed the client (Prosenjit Poddar) and
determined that the client was not dangerous, the plaintiff might not
have had a case to sue.

Supervisor Role and Responsibilities
Inherent and integral to the role of supervisor are responsibilities for:
1. Monitoring client welfare.
2. Encouraging compliance with relevant legal, ethical, and
professional standards for clinical practice.
3. Monitoring clinical performance and professional development
of supervisees.
4. Evaluating and certifying current performance and potential of
supervisees for academic, screening, selection, placement,
employment, and credentialing purposes.

Priority Sequence in Resolving Conflicts
1. Relevant legal and ethical standards (e.g., duty to warn, state
child abuse laws, etc.)
2. Client welfare
3. Supervisee welfare
4. Supervisor welfare
5. Program and/or agency service and administrative needs.

Scope of the Supervisory Relationship
1. The supervisor is the person responsible for the evaluation of the
supervisee, and is able to control supervisee clinical actions.
2. It is the supervisee’s duty to perform the act in question (i.e., doing
therapy with assigned clients).
3. Was the act done within the proper time, place and purpose of the
act (e.g., was the act done in the counseling session or away from
the counseling facility).
4. Whether the supervisor could have reasonably expected the
supervisee to commit the act.

Confidentiality
Jaffee vs. Redmond (1996)
o The family of a deceased individual who was killed by a police
officer attempted in a civil lawsuit to obtain information from the
police officer’s therapist who was a licensed social worker, but not a
licensed psychologist or psychiatrist. This case went all the way to
the Supreme Court who sided with the social worker stating that
legislation (that exists in all 50 states) that creates privilege for
licensed psychotherapists extends to licensed psychotherapists
other than psychologists and psychiatrists.

Confidentiality
 Confidentiality represents the essence of therapy (a safe place
where secrets and hidden fears can be exposed), and because
much of our professional status comes from being the bearer of
such secrets.
 Videotapes and audiotapes are secured and confidential
documents, and all supervisees must understand this.
 Supervisee’s right to privacy and it is the supervisor’s responsibility
to keep information confidential. It is also the supervisor’s
responsibility to ensure the clinician is keeping client information
confidential.

Confidentiality Components
 Confidentiality is defined as: “an explicit promise or contract to reveal
nothing about an individual except under conditions agreed to by the source
or subject” (Siegel, 1979).
 Privacy is defined as: “the client’s right not to have private information
divulged without informed consent, including the information gained in
therapy” (Siegel, 1979).
 Privileged Communication is defined as: “the right of clients not to have
their confidential communications used in open court without their consent”
(Siegel, 1979).

Confidentiality Vignette
As the clinical director, you have been assigned to be the HIV
counselor. Your grant stipulates that all clients must be counseled
and given the opportunity to test for HIV. As part of this title, you
went to the state run training and are certified as an HIV counseling
and testing person (one of two in your agency). Your Executive
Director has taken on a small caseload and comes to you stating
that one of his clients is interested in HIV testing. The client is
scheduled, receives the testing, and the results come back in about
5 weeks.
You inform your E.D. that the results are in, and ask her to schedule
the client to see you to obtain the results. The E.D. then asks you
for the results of the testing. You remember in your training that the
results are strictly confidential between yourself and the client (and
only the client can tell others the results of the testing), and you
state this fact to the E.D.

Confidentiality Vignette
The E.D. becomes defensive and states that the agency runs as a
treatment team and he has the right to know the results of his client’s test.
He starts by stating that 42 CFR – Part 2 allows this exception (clinical team
staffing) to the client’s confidentiality. You state that you were given explicit
instructions during your training that the test results were strictly confidential
information between you and the client, and the information can only be
shared if the client decides to disclose this information to his/her therapist.
The E.D. then becomes angry with you and states that if you don’t hand him
the paper (with the results on it), he will write you up. Sensing your
hesitation and continued rebuttal, she snatches the paper out of your hand
and reads the results of the test. She then publicly reprimands you that
your behavior was inexcusable and will not be tolerated again. You decide
to put off your request for a raise at this time.

Confidentiality Vignette Questions
1. Has the E.D. violated the client’s confidentiality in this matter?
2. If you decide the answer to question 1 is yes, what needs to occur
in this case? With the E.D.? With the client? With the policy you
tried to enforce?
3. Before anything is resolved in this matter, 2 other staff members
come to you asking for the results of their client’s tests. When you
rebuke their request, they bring back the discussion that took place
between you and the E.D. and insist on getting the results. What
steps need to happen here?

Exceptions to Confidentiality
1. Suicidal/Homicidal Risk
2. Medical Emergency
3. Court Order
4. Child/Elder Abuse
5. Internal Communication (e.g., billing issues, cancelled
appointments).
6. When clients express the intent to commit a crime or when they
commit a crime on the premises (What about admission of a
crime?).
7. When the client initiates a malpractice suit against the therapist or
supervisor.

Exceptions to Confidentiality (continued)
8. No identifying information.
9. Research/Audit and Evaluation.
10. Qualified Service Agreement (3rd Party Payer)

Legal Standards of Confidentiality
13:34-18.5 Confidentiality
a) A licensee shall preserve the confidentiality of a information
obtained from a client in the course of performing professional
counseling services for the client, except in the following
circumstances:
1. Disclosure is required by Federal or State law or regulation;
2. Disclosure is required by the Board or the Office of the Attorney
General during the course of an investigation;
3. Disclosure is required by a court of competent jurisdiction
pursuant to an order;
4. The licensee has information that the client presents a clear and
present danger to the health or safety of an individual;

5. The licensee is a party defendant to a civil, criminal or
disciplinary action arising from the professional counseling
services provided, in which case a waiver of the privilege
accorded by this section shall be limited to that action; or
6. The client agrees, in writing, to waive the privilege accorded by
this section. In circumstances where more than one person in a
family is receiving professional counseling services, each family
member who is at least 18 years of age must agree to the waiver.
Absent a waiver of each family member, a licensee shall not
disclose any information received from any family member.
(b) A licensee shall establish and maintain procedures to protect client
records from access by unauthorized persons.

(c) A licensee shall establish procedures for maintaining the
confidentiality of client records in the event of the licensee’s
relocation, retirement, or death and shall establish reasonable
procedures to assure the preservation of client records.
(d) In the case of a client’s death:
1. Confidentiality survives the client’s death and a licensee shall
preserve the confidentiality of information obtained from the client
in the course of the licensee’s teaching, practice or investigation;
2. The disclosure of information in a deceased client’s records is
governed by the same provision for living clients;
3. A licensee shall retain a deceased client’s record for at least
seven years from the date of last entry, unless otherwise
provided by law.

13:34-18.6 Minors
a) Unless otherwise ordered by a court, if the client is a minor, a parent
or legal guardian will be deemed to be an authorized representative.
When the client is more than 14 years of age, but has not reached
the age of majority, the authorization shall be signed by the client and
by the client’s parent or legal guardian.
b) This section shall not require a licensee to release to a minor’s parent
or guardian records or information relating to the minor’s sexually
transmitted disease, termination of pregnancy, or substance abuse or
any other information that in the reasonable exercise of the licensee’s
professional judgment may adversely affect the minor’s health or
welfare.
c) Unless otherwise ordered by a court, at least one parent or guardian
shall consent to the treatment of a minor. If one parent consents, a
licensee may treat a minor even over the objection of the other
parent.

Case Records & Confidentiality
Suslovich vs. New York State Education Department (1991)
o This was an appeal by a psychologist whose license was
suspended by the state licensing board for a lack of record keeping
regarding a case brought to the board by an insurance company for
fraudulent billing practices. The appeal upheld the ruling on the
grounds that simple record keeping, such as relying on one’s
memory, was not sufficient to provide an adequate record.

Some recommended guidelines:
1. Record no more than is essential to the functions of the agency.
Identify observed facts and distinguish them from opinions.
2. Omit details of clients’ intimate lives from case records; describe
intimate problems in general terms.
3. Do not include process recordings or other clinical supervision
notes in case files.
4. Keep case records in locked files and issue keys only to those who
require frequent access to the files.

5. Do not remove case files from the agency or private practice except
under extraordinary circumstances with special authorization (if in
private practice get permission from … yourself, but only in an
extraordinary circumstance).
6. Do not leave case files on desks where janitorial personnel or
others might have access to them.
7. Use in-service training sessions to stress confidentiality and to
monitor observance of agency policies and practices instituted to
safeguard confidentiality.

 Federal Privacy Act of 1974 was enacted to safeguard people
against “harmful disclosures of information whether through
inaccurate information being used in irrelevant circumstances, or
through inaccurate information being used in important decisions
affecting individuals.”
 Even though this is a federal law, many states have enacted
corresponding statutes to protect people’s rights to privacy.
 The Federal Privacy Act specifies duties for agencies/professionals
that maintain record-keeping systems, including the following:

Agency Record Keeping Duties
1. Maintaining only information relevant and necessary to the
agency’s purposes.
2. Collecting as much information as possible from the client directly.
3. Informing clients of the agency’s authority to gather information,
whether disclosure is mandatory or voluntary, the principal purpose
of the use of the information, the routine uses and effects, if any, of
not providing part or all of the information.
4. Maintaining and updating records to assure accuracy, relevancy,
timeliness and completeness.

Agency Record Keeping Duties
5. Notifying clients of the release of records owing to compulsory legal
actions.
6. Establishing procedures to inform clients of the existence of their
records, including special measures if necessary for disclosure of
medical and psychological records and a review of requests to
amend or correct the records.

Clients Access to their Own Records
 Both the Freedom of Information Act (1966) and the Privacy Act
(1974) establish the right of the client to have access of their own
records.
 Research by Freed (1978) found that agencies that tried sharing
case records with clients have found that the practice contributes
favorably to enhancing client’s trust and the openness of the
therapeutic relationship.
 When should records be withheld?
1. Only in very limited circumstances when there is compelling
evidence that such access would cause serious harm to the client.

13:34-18.3 Access to copy of client record
1. Licensee may request the authorization be in writing.
2. Licensee shall provide a copy of the client record and/or billing records,
including reports relating to the client, no later than 30 days from the receipt
of a request from client or authorized representative.
3. Unless otherwise required by law, the licensee may elect to provide a
summary of the record, as long as the summary adequately and accurately
reflects the client’s history and treatment.
4. Licensee may charge a reasonable fee for the preparation of a summary
and reproduction of records, which shall be no greater than the amount
reasonably calculated to recoup the costs of transcription or copying.
5. This obligation by the licensee includes that of completing forms or reports
required for third party reimbursement of client treatment expenses. No
additional fee may be charged for the completion of health insurance claim
forms.

13:34-18.3 Access to copy of client record
6. When the request is made for continuation of treatment with another
provider or for judicial proceedings, the licensee shall not require prior
payment for the professional service as a condition of making such reports
available. Advance fee payment is allowed for a licensee’s services as an
expert witness.
7. The licensee may withhold information contained in the client record from a
client or the client’s guardian if in the reasonable exercise of his/her
professional judgment, the licensee believes release of such information
would adversely affect the client’s health or welfare. That record or the
summary, with an accompanying explanation of the reasons for the original
refusal, shall nevertheless be provided upon request of and directly to:
1. The client’s attorney;
2. Another licensed health care professional; or
3. The client’s health insurance provider

13:34-18.7 (13:34-30.5[c]) Transfer or disposal
of records
1. A licensee shall notify all current clients in writing the intention to terminate or
interruption of services. The licensee shall seek the transfer, referral or continuation
of service in relation to the client’s needs and preferences.
2. If a licensee ceases to engage in practice or it is anticipated that he/she will remain
out-of-practice for more than 3 months, they must also:
a) Establish a procedure by which clients can obtain a copy of the treatment
records or acquiesce in the transfer of those records to another licensee or
health care professional who is assuming responsibilities for the practice.
However, a licensee shall not charge a client for a copy of the records, when the
records will be used for the purposes of continuing treatment or care.
b) Make reasonable efforts to directly notify any client treated during the six months
preceding the cessation, providing information concerning the established
procedure for retrieval of records; and
c) If a licensee is unable to notify all clients, publish a notice of the cessation and
the established procedure for the retrieval of records in a newspaper of general
circulation in the geographic location of the licensee’s practice, at least once
each month for the first 3 months after the cessation.

Clinical Supervision Recordkeeping
Clinical Supervision Notes:
Clinical supervision notes serve a number of functions, including:
 Gathering evidence for your personal log of reflective practice.
 Helping you to keep a track of your trainee’s professional development
and competence during the course of his/her placement.
 Provides you with evidence to help form a judgment of competence
throughout the continuum, not just at evaluation points.
 Can provide a focus for future supervision issues, such as reflecting on
development later on in the placement.
 Provides a record of decisions, judgments and perspectives taken during
a supervision session.
 Helps a supervisor to keep track of clinical work undertaken by the
trainee.
 Can provide detailed feedback to your trainee.

Notes should be kept in such a way that the reasoning behind opinions and
decisions can be understood.
 Alternative courses of action that have been considered should be noted.
 Alternative points of view, including disagreements between trainee and
supervisor should be noted.
 The way in which disagreements or interpersonal difficulties are resolved
can be noted and are good topic area for future supervision discussions.

Supervision notes are the official record of your supervision practice, over the
course of a supervisee’s placement.
 For the purposes of personal development and reflection, the supervisor
may wish to record personal information, such as countertransference
material (awareness of thoughts about being a supervisor or about the
trainee, strong feelings, activation of schemas) and behavior during a
supervision session. This information will be useful when seeking your
own supervision.
 Be aware however that all records kept in the course of your work can
potentially become a matter of public record should there be a future
court case or licensing board inquiry.

NBCC Code of Ethics: Recordkeeping
 Certified counselors must ensure that data maintained in electronic storage
are secure. By using the best computer security methods available, the data
must be limited to information that is appropriate and necessary for the
services being provided and accessible only to appropriate staff members
involved in the provision of services. Certified counselors must also ensure
that the electronically stored data are destroyed when the information is no
longer of value in providing services or required as part of clients’ records.
 Any data derived from a client relationship and used in training or research
shall be so disguised that the informed client’s identity is fully protected. Any
data which cannot be so disguised may be used only as expressly
authorized by the client’s informed and un-coerced consent.

Informed Consent
 "Informed consent" is a process of sharing information with clients
that is essential to their ability to make rational choices among
multiple options in their perceived best interest.
 Informed consent was founded as a legal standard of care on the
principle of individuals' rights over their own bodies and was well
established by the turn of this century.
 Informed consent had been enforced progressively: first for surgical
procedures, then medical (non-surgical) ones, and finally for
medication itself.
 Until recently mental health and addictions counseling had largely
avoided this standard.

Informed Consent
 According to Beahrs & Gutheil (2001) several factors traditionally
shielded psychotherapy from standard of informed consent:
1. “First and foremost was that therapeutic communications were
considered sacrosanct and rarely made available to others in
uncensored form.”
2. “An additional distinction was the fact that psychotherapy is
physically noninvasive, with patients being conscious and able
to monitor the process themselves.”
3. “Finally, the multiple uncertainties and complexities that can
influence the outcome of treatment for a mental disorder make
it very difficult to demonstrate convincingly any specific harm
allegedly caused by the psychotherapeutic process itself.”

Informed Consent
 The supervisor must determine that clients have been informed by
the supervisee regarding the parameters of therapy.
 The supervisor must also be sure that clients are aware of the
parameters of supervision that will affect them.
 Supervisor must provide the supervisee with the opportunity for
informed consent (i.e., the conditions and parameters that dictate
their existence in their workplace).
 A clinician shall not withhold information that the client needs or
reasonably could use to make informed treatment decisions,
including options for treatment not provided by the clinician.

Informed Consent with Clients
 What are the reasonable risks of therapy?
 What are the reasonable benefits of therapy?
 What are the logistics of treatment (cost, length of sessions, number
of sessions)?
 What are the financial incentives or penalties which limit the
provision of appropriate treatment (especially when dealing with
third party providers, and the limitations imposed by those payers)?
 What type of therapy will be offered (what is your theoretical
orientation … cognitive behavioral, marital, gestalt)?

Informed Consent Regarding Supervision
 All clients should be informed of the supervisory process upon the first
session (and what that will mean for each client, what level of supervision).
 Supervisor may want to meet with the client of supervisee for a number of
reasons:
1. By meeting the supervisor directly, the client usually is more
comfortable with the prospect of supervision.
2. It gives the supervisor an opportunity to model for supervisee’s the
kind of direct, open communication that is needed for informed
consent.
13:34-13.1(g) – Prior to an LAC’s commencement of client treatment, the
supervisor shall obtain a written disclosure, which shall be signed by the
client and retained as part of the client record, acknowledging that the client
has been informed that services are being by an associate counselor under
the supervision of a professional counselor or a qualified supervisor as
defined in N.J.A.C. 13:34-10.2

Informed Consent Vignette
You are supervising an MA intern in a behavioral healthcare outpatient
facility. This trainee sees a client for the first time and begins doing the
intake information. You view the tape of the client and trainee, and let him
know that he forgot to inform the client about the procedure of therapy, cost,
and the risk/benefit of entering into therapy. You model how this should be
done (as this is the intern’s first client), and assign this as the first task to
happen during the next session. You also tell the intern that the tasks at
hand (for the next couple of sessions) are completing the intake
(assessment phase) forms, assessing client
needs/wants/problems/strengths, and formulating agreed upon treatment
goals. The intern states he understands.
Next session, the intern follows your instructions and provides the informed
consent you requested. He then continues with ASI and other standardized
assessment forms with the client. During the session the client begins to
talk about some of his problems, and your intern seizes the moment to do
some guided imagery with him regarding the problem he was talking about
(feeling abandoned by his father). After the exercise, the intern continues to
fill out assessment forms.

After viewing the tape, you caution the intern not to get ahead of himself
and start doing therapy (guided imagery exercise). You also informed the
intern that he did not explain this technique to the client, nor did he ask the
client’s permission to utilize this technique. You clearly outline to the intern
what should happen in the next session (restating what was said previously
regarding assessment stage tasks).
The next session, the intern again continues to complete assessment
forms, when the client discloses that he feels inept as a father. A light
flashes in your interns mind, and he discloses to the client that privately he
does work with a men’s movement organization. This organization helps
men “gain integrity with themselves, with their family of origin, and with their
current family’s structure.” He informs the client of a powerful technique he
knows which involves blindfolding the client and leading the client around
the room while the therapist asks him questions about his manhood and
fatherhood. The client agrees to have this procedure done.

Excited at the prospect of doing his “life’s work” with the client, the intern
scrambles to make a makeshift blindfold. He then stands the client up,
holds the client’s hand, leads the client walking around the room asking the
client a series of questions (e.g., “In what way are you less than a whole
man” and “In what way are you strong”).
Excited about the exercise he just did, and before his next scheduled
supervision session with you, the intern describes to the staff (in peer
supervision meeting) the details of the aforementioned exercise and his
rationale for doing the exercise. In the questioning of this intern, you sense
some concern from some other clinicians (e.g., one clinician asked if the
client consented to this procedure and the intern stated he fully explained
the procedure to the client before proceeding). At one point the meeting
gets quiet and people look to you to see if you have any feedback to give
your intern.

Informed Consent Vignette Questions
1. Has the MA intern properly done informed consent in this case
example?
2. What feedback should you give the intern in peer supervision
meeting?
3. Once you get this intern alone, what next?

Americans with Disabilities Act
 The ADA Amendments Act of 2008 (ADAAA) was enacted on
September 25, 2008, and became effective on January 1, 2009.
 This law made a number of significant changes to the definition of
“disability.”
 It also directed the U.S. Equal Employment Opportunity
Commission (EEOC) to amend its ADA regulations to reflect the
changes made by the ADAAA.
 The final regulations were published in the Federal Register on
March 25, 2011.

 Who is not affected by the ADA?
 Corporations fully owned by the U.S. Government (though the U.S.
government is are covered by similar regulations promulgated by
other disability and discrimination laws.
 Indian Tribes.
 Bona fide private clubs that are exempt from taxation under the
Internal Revenue Code.
 Private clubs and religious organizations are exempt from Title III
(public accomodation) provisions.

 The ADAAA and the final regulations define a disability using a
three-pronged approach:
1. a physical or mental impairment that substantially limits one or more
major life activities (sometimes referred to in the regulations as an
“actual disability”), or
2. a record of a physical or mental impairment that substantially limited
a major life activity (“record of”), or
3. when a covered entity takes an action prohibited by the ADA
because of an actual or perceived impairment that is not both
transitory and minor (“regarded as”).

 Definition of a person with a disability (continued)
 As defined by the ADA, a disability is a physical or mental
impairment that substantially limits a major life activity, such as
caring for oneself, performing manual tasks, seeing, hearing, eating,
sleeping, walking, standing, sitting, reaching, lifting, bending,
speaking, breathing, learning, reading, concentrating, thinking,
communicating, interacting with others, and working.
 The final regulations also state that major life activities include the
operation of major bodily functions.
 The final regulations state that major bodily functions include the
operation of an individual organ within a body system ( e.g., the
operation of the kidney, liver, or pancreas).

 What is “substantially limit” a major life activity mean?
 The individual must be substantially limited in performing a major life activity
as compared to most people in the general population.
 The determination of whether an impairment substantially limits a major life
activity requires an individualized assessment.
 An impairment need not prevent or severely or significantly limit a major life
activity to be considered “substantially limiting.” Nonetheless, not every
impairment will constitute a disability.
 An individual need only be substantially limited, or have a record of a
substantial limitation, in one major life activity to be covered under the first
or second prong of the definition of “disability.”

 Do the final regulations require that an impairment last a particular length of
time to be considered substantially limiting?
 In prong 3 (“regarded as” prong) ADAAA excludes from “regarded as”
coverage an actual or perceived impairment that is both transitory ( i.e., will
last fewer than six months) and minor.
 An impairment that is episodic or in remission meets the definition of
disability if it would substantially limit a major life activity when active.
 Employment discrimination can also include discriminating based on a
qualified individual’s relationship or association with another individual (such
as a spouse or child) with a known disability.

 Reasonable Accommodation:
 Making reasonable accommodation for the disability of a qualified applicant
or employee is key to the successful employment of people with disabling
conditions.
 The ADA defines reasonable accommodation as efforts that may include
the following adjustments (these are major examples, but not a
comprehensive list):
1. Making the workplace structurally accessible to people with
disabilities.
2. Restructuring jobs to make best use of an individual’s skills.

 Reasonable Accommodation (continued):
3. Modifying work hours.
4. Reassigning an employee with a disability to an equivalent
position as soon as one becomes available.
5. Acquiring or modifying equipment or devices.
6. Appropriately adjusting or modifying examinations, training
materials, or policies.
7. Providing qualified readers for the blind or interpreters for the deaf.

 ADA and Drug Use:
 The definition of an individual with a disability does not include anyone who
is currently engaged in the illegal use of drugs.
 However, a person who has successfully completed a supervised drug
rehabilitation program or has otherwise been rehabilitated successfully, or
is participating in a supervised rehabilitation program is covered. ADA gives
additional authority to employers:
1. Employers may utilize drug testing to ensure that individuals who
have completed or are enrolled in rehabilitation programs remain
drug free.
2. Employers may prohibit the use of drugs and alcohol at the
workplace.
3. Hold all employees, regardless of disability, who abuse drugs or
alcohol to the same job performance criteria as other employees.
4. An employer will have to prove Financial or Resource Hardship in
order not to provide reasonable accommodations.

Dual Relationships
o When a supervisor extends the boundary beyond the workplace,
and specifically the supervisory relationship, the supervisory creates
the potential for complications.
o Dual relationships occur when a person assumes two or more roles
simultaneously or sequentially with a person seeking help (client) or
with a person being supervised.
What makes a dual relationship unethical?
1. The likelihood that it will impair the supervisor’s judgment.
2. The risk to the supervisee of exploitation.

Sexual Involvement, Sexual Harassment,
Harassment
 Sexual Attraction
 Sexual Harassment – Harassment in the workplace needs to be a pattern of behavior
or a single egregious incident. There has been case precedent (3) for the latter in
NJ.
 ‘ “Harassment” means deliberate comments, contacts, or gestures which intimidate or
offend an individual on the basis of that person’s race, religion, color, national origin,
marital status, sexual orientation, physical or mental disability, or any other
preference or personal characteristic, condition or status.’
 It recently got easier for accusers to show they have suffered as a result of
harassment.
 The New Jersey Supreme Court ruled in 2004 that victims of workplace sexual
harassment can sue employers for emotional stress without having to demonstrate
through experts they suffered severe psychological harm.

Sexual Involvement, Sexual Harassment,
Harassment
 ‘ “Sexual Harassment” means solicitation of any sexual act, physical advances, or verbal
or nonverbal conduct that is sexual in nature, and which occurs in connection with a
licensee’s activities or role as a provider of professional counseling services and that is
either unwelcome, offensive to a reasonable person, or creates a hostile work place
environment, and the licensee knows, should know, or is told this, or is sufficiently severe
or intense to be abusive to a reasonable person in that context. “Sexual Harassment” may
consist of a single, extreme or severe act, or of multiple acts, and may include, but is not
limited to the conduct of a licensee with a client, co-worker, employee, student, supervisee
or research subject, whether or not such individual is in a subordinate position to the
licensee.’
 Some definitions of sexual harassment also include the following line: ‘ “Sexual
Harassment” may include content of a nonsexual nature if it is based upon the sex of an
individual.’
 Consensual (but Hidden) Sexual Relationships. “Sexual involvement may further a human
relationship, but it does so at the expense of the professional relationship” (Rubin, 1990).
 (FOR SUPERVISORS) Intimate Romantic Relationships. The American Psychiatric
Association, while discouraging all sexual involvement between clinicians and trainees,
“realized that romantic relationships often develop in professional settings and that it in no
way intended to stifle them.”

Nonsexual Dual Relationships
 Supervisor/Therapist (the supervisor will be challenged
at times to determine where supervision ends and
therapy begins).
 Supervisor/Recovery (how does recovery issues, AA
attendance, sponsoring).
 Professional/Personal (just how personal is too
personal)?

13:34-30.4 and 13:34-30.6 Dual
Relationships/Conflicts of Interest
a) LPC, LAC shall not provide services in circumstances that would expected to
limit the counselor’s objectivity and impair professional judgment or increase
the risk of exploitation.
b) LPC, LAC shall not enter into any relationship that would be expected to limit
objectivity and impair professional judgment or increase the risk of exploitation
(e.g., professional treatment of business or financial relationships, students,
supervisors, friends or relatives, supervision of friends and relatives and receipt
of any goods and/or services from a client).
c) LPC, LAC who has identified areas of conflict of interest shall notify the parties
involved and shall take action to eliminate the conflict.
d) LPC, LAC shall not refer a client to a service in which the counselor or his/her
immediate family have a financial interest.

NBCC Code of Ethics on Harassment
11. 11. Certified counselors do not condone or engage in sexual harassment,
which is defined as unwelcome comments, gestures, or physical contact of a
sexual nature.
12. 12. Through an awareness of the impact of stereotyping and unwarranted
discrimination (e.g., biases based on age, disability, ethnicity, gender, race,
religion, or sexual orientation), certified counselors guard the individual rights
and personal dignity of the client in the counseling relationship.

Sexual Relationships with Clients
 National Board for Certified Counselors – Sexual, physical, or romantic intimacy can be engaged
within a minimum of 2 years after terminating the counseling relationship.
http://www.nbcc.org/Assets/Ethics/nbcc-codeofethics.pdf (Section A10).
 American Counseling Association – 5 years (clients only). Must demonstrate forethought and
document no potential harm or exploitation will occur.
http://www.counseling.org/Files/FD.ashx?guid=ab7c1272-71c4-46cf-848c-f98489937dda (Clients:
Section A5. Colleagues/Students: Section F.3.b. no sex with only current supervisees)
 American Psychological Association – 2 years … for those “most unusual circumstances”.
http://www.apa.org/ethics/code/index.aspx (Clients: regulation 10.08, Colleagues/Students:
regulation 7.07).
 National Association of Social Workers – No sex, no time, no how … unless the social worker can
prove an exception to this prohibition is “warranted because of extraordinary circumstances” and the
social worker must prove it (NASW). 2 years (LCSW).
http://www.socialworkers.org/pubs/code/code.asp (Clients: regulation 1.09, Colleagues/Students:
regulation 2.07).
LSW/LCSW Code of Ethics - http://www.njconsumeraffairs.gov/laws/socialregs.pdf (13:44G-10.7[c]
and [c1]).

Sexual Relationships with Clients
 American Association for Marriage and Family Therapists – 2 years.
http://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx (Section 1.5).
http://www.njconsumeraffairs.gov/laws/mftregs.pdf (Section 13:34-6.4 [d and d(1)]).
 Licensed Professional Counselor (LPC) – 2 years. Being in love and consensual relationships are not
defenses.
 http://www.nj.gov/oag/ca/laws/pcregs.pdf (Section 13:34-19:3[b, c, h, and i]).
NJ LCSW, LPC and LMFT all read the same exclusion: “In the circumstances where the client is, or should
be recognized by the licensee as, clearly vulnerable by reason of emotional or cognitive disorder to the
exploitive influence by the licensee, the prohibition on sexual contact shall extend indefinitely.”
 CADC/LCADC – Again, 2 years.
http://www.njconsumeraffairs.gov/laws/adcregs.pdf (13:34C-3.3[c and c(1)d]).
CADC/LCADC exclusion: “The 24 month rule shall not apply and the prohibition shall extend indefinitely in
the circumstances where the former client is or should be recognized by the licensee or certificate holder as
clearly vulnerable by reason of emotional or cognitive disorder to the exploitive influence by the licensee or
the certificate holder.”
All links were checked on 02/17/12

Dual Relationship Vignette
Ann is your intake coordinator at the residential facility you head (as Clinical
Director). One of the responsibilities you have given Ann is the scheduling
of overnight staff. She does not have any type of supervisory capacity other
than scheduling the overnight workers. It has come to your attention,
through one of the clients, that Ann has begun a romantic relationship with
one of the overnight workers. At this point you don’t do anything regarding
this information.
3 weeks later, one of the other overnight workers approaches you with a
complaint directed towards Ann. He states that she is playing favorites with
Rodney (the alleged boyfriend). He shows you the overnight schedule and
shows how Rodney has almost every weekend off, while the other 2
overnight workers fill in the majority of weekend shifts. He asks for your
help to correct this situation and does not want his name put out to Ann. He
states the reason for this favoritism by Ann towards Rodney is due to their
romantic involvement with each other, and the fact that Ann has weekends
off.

Dual Relationship Vignette Questions
1. Is there a dual relationship issue in this example, if so
what is it?
2. Since Ann has not publicly stated she and Rodney are
romantically involved, how do you go about dealing with
this situation?
3. If in your conversations with Ann, she does admit to this
relationship, what call do you make regarding their
relationship in regards to professional functioning?

LAC Clinical Supervision Standards
13:34-10.2 – Definition of Supervision
 ‘ “Supervision” or “supervised” means the weekly interaction with a qualified
supervisor who monitors the performance of the licensed associate
counselor and provides weekly, documented, face-to-face consultation,
guidance and instruction with respect to the counseling skills and
competencies of the LAC, which includes at least 50 hours of face-to-face
supervision per one calendar year, at the rate of one hour per week, of which
not more than 10 hours may be group supervision.’
 ‘ “Direct supervision” means the ongoing process of supervision by a
qualified supervisor who is immediately available (either in person, or by
electronic means of communication and is available to engage in a dialog
with the supervisee to provide guidance and direction).

13:34-10.2 and 13:34-13.1 – Definition of Qualified Supervisor
a) “Qualified Supervisor” an individual who holds a clinical license to provide mental health
counseling services for a minimum of two years (obtaining at least 3,000 hours work
experience subsequent to holding the license in a minimum of 2 years but no more than 6
years) in the state where the services are being provided, and who has:
1. A clinical supervisor’s certificate from the National Board for Certified Counselors
Center for Credentialing and Education or its successor, or the American Association
of Marriage and Family Therapy or its successor.
2. On or after October 5, 2011 shall hold an approved clinical supervisor credential from
the Center for Credentialing and Education of the NBCC or an equivalent clinical
supervisor credential recognized by individual’s respective healthcare licensing board.
3. Completed a minimum of three graduate credits in clinical supervision from a
regionally accredited institution of higher education.
4. Those LPC’s currently engaged as supervisors who do not meet the 3,000 hour
requirement must cease such supervisory relationships by 10/5/09.

13:34-13.1 – Supervisor Qualification, Supervisor
Responsibilities
b) A qualified supervisor shall be responsible for creating a written supervision plan with the
LAC. The supervision plan shall outline:
1) Work setting
2) LAC’s job description
3) Nature of LACs duties and qualifications
4) Nature of supervisor’s duties and qualifications
c) The written supervision plan shall be approved by the Committee prior to the performance
of counseling by the LAC. The DCA Committee also requires they are aware of this
supervisory relationship in writing, which is done by submitting the Proposed Plan of
Supervised Counseling Experience (which can be found on the LPC website
or in your USB under the folder “Laws Regulations and Standards”) to them (in
which you will attach your vita and your written supervision plan).

Responsibilities
d) A qualified supervisor shall perform and document the following activities with the LAC:
1) The supervisor shall perform at least one of the following activities with the LAC:
i. Work as co-counselor with the LAC;
ii. Observe the LAC’s sessions with clients;
iii. View videotapes of the LAC ‘s session with clients;
iv. Listen to audiotapes of the LAC’s session with clients;
2. The supervisor shall perform at least one of the following activities with the LAC:
i. React to case presentations given by the LAC;
ii. Conduct role-playing sessions with the LAC;

Responsibilities
d) A qualified supervisor shall perform and document the following activities with the LAC:
3) The supervisor shall perform all of the following activities with the LAC:
i. Engage in problem-solving discussions with the LAC concerning individual
clients;
ii. Enter into problem-solving discussions concerning the LAC’s own problems that
affect the LAC’s work with clients;
iii. Offer feedback to the LAC concerning specific interventions utilized with clients;
iv. Offer feedback to the LAC concerning the LAC’s personal qualities as they affect
work with clients; and
v. Offer feedback to the LAC concerning the supervision experience.
d) A qualified supervisor shall maintain all documentation with respect to the supervision
provided to LAC’s for a minimum of 3 years. A qualified supervisor shall attest to
compliance with the supervision requirements of these regulations by completing all forms
provided by the Committee.

Responsibilities
f) A qualified supervisor shall not supervise more than a total of six (6) mental health
counselors at any one time. 13:34-10.2 - “Group supervision” means the ongoing process
of supervising no more than six (6) mental health counselors at one time in a group setting
by a qualified supervisor.
g) Prior to an LAC’s commencement of client treatment, the supervisor shall obtain a written
disclosure, which shall be signed by the client and retained as part of the client record,
acknowledging that the client has been informed that services are being by an associate
counselor under the supervision of a professional counselor or a qualified supervisor as
defined in N.J.A.C. 13:34-10.2. If part of another document, it must be easily readable,
clearly understood, signed by the client and retained as part of the client record.
h) A qualified supervisor shall retain full professional responsibility for collecting fees from
clients.

Responsibilities
i) A qualified supervisor shall be responsible for knowing the name and either the diagnosis
or the nature of the problem of each client being treated by the LAC. A supervisor shall be
ultimately responsible for the welfare of the client with respect to the treatment being
rendered by the LAC.
j) A qualified supervisor shall ensure that the LAC maintains, on an annual basis until the
LAC is licensed as an LPC, documentation of supervised experience , using the forms
provided by the Committee for that purpose. The supervisor shall attest to compliance with
the standards set for in these regulations and shall indicate the hours and dates during
which the LAC has been under supervision, the nature of the cases assigned and the
proficiency rating earned by the LAC.
k) A qualified supervisor shall supervisor only in areas for which he/she possesses the
requisite skills, training and experience.

Responsibilities
l) A qualified supervisor shall not supervise an individual with whom supervisor has a
relationship that may compromise the objectivity of the supervisor or impair the professional
judgment of the supervisor (e.g., current and former clients, current employers, relatives of
the supervisor, immediate relatives of current clients, current students or close friends).

13:34-13.2 – Responsibilities of LAC’s
a. Maintain documentation of supervised experience.
b. Not engage in practice under supervision in any area for which the LAC
has not had appropriate training and education.
c. LAC may not engage in unsupervised or independent practice.
d. LAC shall not receive a fee from a client and may be compensated only
through supervisor or employer.
1. Nothing in this subsection shall be construed to prohibit a licensed
associate counselor from receiving from a client, on behalf of the
supervisor or employing entity, fees for professional services.
e. LAC shall not advertise professional services.

13:34-13.3 SUPERVISED PROFESSIONAL COUNSELING
EXPERIENCE ACQUIRED PRIOR TO APPLICATION
a) An applicant may be granted up to one calendar year of supervised
professional counseling experience credit towards fulfillment of the supervised
professional counseling experience requirements for licensure as a professional
counselor if the supervised experience hours occurred before the granting of the
master's degree as part of college or university graduate courses which are
practicums or internships, provided the courses labeled practicums or internships
are not also used to satisfy the educational requirements.
b) An applicant may be granted supervised professional counseling experience
credit towards the fulfillment of experience requirements for licensure as a
professional counselor if the supervised experience occurred after the granting of
the master's degree and after the applicant was licensed as an associate
counselor and the experience was supervised by a qualified supervisor as
defined in N.J.A.C. 13:34-10.2.

13:34-13.3 SUPERVISED PROFESSIONAL COUNSELING
EXPERIENCE ACQUIRED PRIOR TO APPLICATION
c) An applicant may be granted credit towards the fulfillment of the supervised
professional counseling experience requirement for licensure as a professional
counselor if the experience hours occur as part of a planned post-master's
degree program in counseling in an accredited college or university designed to
meet the requirements for licensure as a professional counselor.
d) An applicant may purchase the services of a qualified supervisor if the
supervision occurs in a professional counseling setting and the supervisor fulfills
the activities and responsibilities of a supervisor as set forth in N.J.A.C. 13:34-
13.1.

Miscellaneous Ethical/Legal LAC and LPC Standards
 No Bartering. Included in this under sexual misconduct section is no exchanging
sexual activities for services rendered.
 A licensee shall not engage in sexual harassment inside OR outside the professional
setting, and could be held accountable for this occurring either inside or outside the
professional setting.
 5 digit license number must be used after name and license title on advertisements
and business representation including business cares, stationary and directory
listings.
 Continuing education credits for teaching coursework (1½ CE hours credit for each
hour taught, up to a maximum of 9 hours CE contact hours, 15 hours if teaching
graduate coursework). The coursework must be “new” meaning the LPC must not
have previously presented this material.
 LAC’s can accrue 1,500 hours per year (or 125 hours per month, or 30 hours per
week) towards their LPC as long as they are supervised by a qualified supervisor.
Unlicensed work in master’s level internships and practicum's can account towards a
maximum of 1 calendar year of the hours needed for their LPC.

Bibliography
42-CFR-Part 2: Title 42--Public Health CHAPTER I--PUBLIC HEALTH SERVICE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 2--CONFIDENTIALITY OF
ALCOHOL AND DRUG ABUSE PATIENT RECORDS
http://www.access.gpo.gov/nara/cfr/waisidx_02/42cfr2_02.html
Association for Counselor Education and Supervision (ACES). (2001). Ethical Guidelines for
Counseling Supervisors. http://www.siu.edu/~epse1/aces/documents/ethicsnoframe.htm [online,
link no longer active]
Beahrs, J. O. & Gutheil, T. G. (2001). Informed consent in psychotherapy. The American Journal
of Psychiatry, 158(1), 4-10.
Bernard, J. M. & Goodyear, R. K. (2013). Fundamentals of Clinical Supervision, 5th
Ed. Pearson,
Boston, MA.
Disney, M. J. & Stephens, A. M. (1994). Legal Issues in Clinical Supervision. ACA Press,
Alexandria, VA.
Division of Consumer Affairs, State Board of Marriage and Family Therapy Examiners, Alcohol
and Drug Counselors Committee. (2009) October 9th
, 2009 Rule Adoption for Alcohol and Drug
Counselors.
Durham, T. G. (1996). The Supervisor’s Role in Ethical Decision-Making. The Counselor.
May/June, p. 7.

Bibliography
Duty to Warn and Protect in New Jersey (originally written in 1991 and amended in
2009) - http://law.onecle.com/new-jersey/2a-administration-of-civil-and-criminal-
justice/62a-16.html
Flinders, C. A. & Shafranske, E. P. (2004). Clinical Supervision: A Competency-
Based Approach. American Psychological Association, Washington, DC.
Falvey, J. E. (2002). Managing clinical supervision: Ethical practice and legal risk
management. Pacific Groove: Wadsworth
Godlaski, T. M. & Leukefeld, C. G. (1996). Ethics of Supervision. The Counselor.
May/June, pp. 17 – 20.
Keith-Spiegel, P. & Koocher, G. P. (1985). Ethics in Psychology: Professional
Standards and Cases. McGraw-Hill, New York, NY.
Knapp, S. & Tepper, A. M. (1996). Legal and Ethical Issues in Supervision.
http://www.papsy.org/ Taken from The Pennsylvania Psychologist Quarterly. [online]
Knapp, S. & Vandecreek, L. (1997). Ethical and Legal Aspects of Clinical
Supervision. In Watkins, C. E. Jr., Handbook of Psychotherapy Supervision. New
York, John Wiley & Sons, Inc.

Bibliography
Lamb, D., Presser, N., Pfost, K., Baum, M., Jackson, R., & Jarvis, P. (1987).
Confronting Professional Impairment During the Internship: Identification, Due
Process, and Remediation. Professional Psychology: Research and Practice, 18, pp.
597-603.
Mead, D. E. (1990). Effective supervision: A task-oriented model for the mental health
professionals. Brunner/Mazel, Inc., New York, NY.
Powell, D. J. & Brodsky, A. (2004). Clinical Supervision in Alcohol and Drug Abuse
Counseling. Jossey-Bass Publishers, San Francisco, CA.
Seigel, M. (1979). Privacy, Ethics and Confidentiality. Professional Psychology, 10,
pp. 249-258.
Slovenko, R. (1980). Legal Issues in Psychotherapy Supervision. In A. K. Hess, Ed.,
Psychotherapy Supervision: Theory, Research and Practice. New York, NY. Wiley.

Bibliography
Stoltenberg, C. D., McNeil, B., & Delworth, U. (1998). IDM Supervision: An Integrated
Developmental Model for Supervising Counselors and Therapists. Jossey-Bass Publishers, San
Francisco, CA.
Woody, R. H. (2013). Legal Self-Defense for Mental Health Practitioners, Springer Publishing
Company, Boston, New York, NY.
The definitions of “Sexual Harassment” and multiple regulations (including, but not limited to,
13:34-10.2, 13.34-13.1, 13.34.18.3, 13.34-18.5) were taken from the NJ State Board of Marriage
and Family Therapy (LAC/LPC) Statutes and Regulations:
http://www.nj.gov/oag/ca/laws/pcregs.pdf, October 5, 2009.
The definition of “Harassment” and the additional line of “Sexual Harassment” were taken from
the NJ State Board of Social Work Examiners (LSW/LCSW) Statutes and Regulations:
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Bibliography
Bond, T. (2015). Standards and Ethics for Counselling in Action, 4th
Ed. Sage, Los Angeles.
Welfel, E. R. (2015). Ethics in Counseling and Psychotherapy: Standards, Research, and Emerging
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Pope, K. & Vasquez, M. J. T. (2016). Ethics in Psychotherapy and Counseling: A Practical Guide, 5th
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