Rogerian ArgumentTaken from the principles of psychologi.docx

Rogerian Argument
Taken from the principles of psychologist Carl Rogers
Origins of this
principle
Based on Carl Rogers’ theory that people involved in
disputes should not respond to each other until they fully and
fairly state the other person’s position.
4 Parts of the Rogerian Argument
1. Introduction
2. Contexts
3. Writer’s position
4. Benefits to opponent
1. Introduction
The writer describes an issue well enough to show that he/she
fully understands and respects the alternative position.

“Let’s meet in the middle.”
2. Contexts
The writer describes cases/contexts in which the alternative
position may be legitimate.
“You may be right sometimes…”
3. Writer’s
Position
The writer states her/his position and presents circumstances in
which it is valid. This is where the writer supports her/his views
with evidence.
“This is why my position is right.”
4. Benefits to
Opponent
The writer explains to the opponent how he/she would benefit
from adopting the writer’s position.
“See what you might gain by agreeing
with me?”

Summation
Rogerian arguments steer clear of incendiary and stereotypical
language.
They emphasize how both sides of the argument might benefit
by working together.
They advocate a win-win outcome.
1
Comprehensive Client Family Assessment
Demographic Information
Date of assessment: 09/14/2018.
DOB: 011/01/1970.
Age: 48.
Race: Black.
SSN: 000000001. Ethnicity: African American.
Address: On file. Tel: 972-000-0000.
Residential Status: Homeless.
County: 9K. Military Status: None.
Language: English.
Interpreter Needed: No.
Primary Insurance: Uninsured.
Annual Gross Income: $0.
Employment Status: Unemployed.
Number of people in the household: 1.

Highest Grade: 11.
School Attendance for the past 3 Months: None.
Arrival Time: 1000 Time Disposition Completed: 1100
Location of client: Lake Worth Nursing Home
Presenting Problem
“My meds are not working.”
History of Present Illness
The patient is presenting with suicidal ideation with a plan and
intent to jump off the bridge or self-stabs with a knife. The
patient complained about his medication, Latuda is no longer
working. Currently homeless with no job or income. Though
calm, polite, and cooperative with organized thoughts, patient
reports depression and anxiety (American Psychiatric
Association, 2013).
Past psychiatric history
1- Major Depressive disorder, Recurrent Episode with psychotic
features
2- Alcohol use disorder; severe
3- Bipolar I Disorder most recent episode depressed Severe
Medical history
None Reported
Substance use history
Alcohol Abuse: began drinking at age 15 and drinks 8 to 10
bottles of beer daily, yesterday was his last time he drank.
Developmental history
None Reported

Family psychiatric history
Positive for family history of mental illness on the paternal
side.
Psychosocial history
The patient is unemployed and enjoys hanging out with fellow
drunkards on the street with drinks, a living condition currently
unstable as the patient is homeless.
History of abuse/trauma
The patient suffered abuse paternal uncle at age 12.
Review of systems
General: significant weight gain recently, positive with fatigue,
but no fever or a cough.
HEENT: vision and hearing changes not reported at this time,
no history of glaucoma, cataracts, diplopia, floaters, excessive
tearing or photophobia, last eye exam four years ago. No ear
infections, tinnitus or discharges in the ear, have no problems
with smell, and taste. Denies epistaxis or nasal drainage, no any
loose teeth, mouth sores or bleeding gum when brushing teeth.
No difficulty with chewing or swallowing.
Neck: positive for JVD, no bruits
Respiratory: Denies shortness of breath, labored breathing,
cough, but could be exposed to TB.
Cardiovascular: S1 and S2, RRR. No Shortness of breath
reported, denies chest pain, palpitations, No difficulty during

exercise.
GI: No nausea, vomiting, heartburn, indigestion. No changes in
bowel/bladder pattern, bowel sounds present on all four
quadrants.
GU: No change in urinary pattern, hematuria or dysuria.
Musculoskeletal: WNL, No joint pain or swelling.
Psych: Positive for the history of mental health, reports anxiety,
depression suicidal ideation but no homicidal thoughts.
Neuro: Alert, oriented x 3, no fainting, dizziness, or loss of
coordination, positive for weakness.
Skin: warm to touch and moist, denies any skin changes, rashes
or raised lesions, no itching, no history of skin disorders or
cancers, no swelling.
Hematologic: No bleeding disorders or clotting issues, no
history of anemia or blood transfusions.
Allergic/Immunologic: Penicillin- rash and seasonal allergies,
Sulfa drugs - rash.
Physical assessment
Vital signs: B/P 130/78; P 70 regular; T 98.4 orally; RR 20 non-
labored; RBS 100mgdl; Wt: 140 lbs.; Ht: 5’6; BMI 22.6.
Mental status exam
The level of consciousness: cerebral perfusion, coherent
thought, concise responses.
Mood: Depressed and sad.
Behavior: Appropriate/Normal and cooperative.
Cognition: displays signs of hallucination and compulsion.
Personal hygiene and grooming: deteriorated grooming and
personal hygiene.

Memory and attention: AO x 3.
Differential diagnosis
features
4- Recurrent Episode with psychotic features (DSM-5, 2018).
Columbia Suicide Severity Rating Scale:
1- Wish to be dead: Yes
2- Suicidal thoughts: yes
3- Suicidal thoughts with method (with a specific plan and
intend to act): Yes
4- Suicidal Intend (with particular plan): Yes
5- Suicidal Intend with a specific plan; Yes
6- Suicidal behavior question: Yes
If yes to 6, how long ago did you do any of these: Over a year
ago (American Psychiatric Association, 2013).
Case formulation

Association, 2013).
Treatment plan
The client will begin an antidepressant Sertraline (Zoloft) 25
mg PO daily for the next four week and monitor progress. Start
patient on an alcohol detox program to help with dependency
and encourage to client join the alcohol anonymous (AA) group
for support (Wheeler, K., 2014).
Assessing Client Progress 4
Assignment 2: Practium- Assessing Client Progress
Name:
Course:
Professor:
School:
City and State:
Date:
Question
Differentiate progress notes from privileged notes
Privileged records is a set of information which involves only
two parties, the client and the therapist and this information

remains confidential, and even the law does not permit forceful
disclosure of the content. On the other hand, a progress note is a
medical record where a medical practitioner or psychiatrist
records details of a patient, the clinical status and the progress
they have made during therapy.
Question
• Reflect on the client you selected for the Practicum
Assignment.
• Review the Cameron and Turtle-Song (2002) article on this
week’s Learning Resources for guidance on writing case notes
using the SOAP format.
Progress Note
Name of Patient:
Date:
Subjective
Amabella suffers from mental distress as a result of being in an
abusive marriage for almost fifteen years. Due to the constant
abuse, she has developed mild depression as well as anger
issues. Her health has deteriorated which has led to weight loss
caused by malnutrition.
I have gone through her past medical history in an attempt to
investigate any medications she has been under in the past. I
have also enquired about any family or social history that would
have led to her condition. (Dick, S, 1999, 41)
Objective
Her physical exam findings show that her body is bruised and
full of stubborn scars which are a result of being forcefully
grabbed or hit with blunt objects. Her neck also reveals that she
has been chocked severally. Also, there is a fresh wound cut on
her face.
Assessment

The therapeutic sessions have been productive. Amabella is
collaborative and is improving. She is open when talking about
why she thinks her husband is an animal and whether he can
change or not. She does not get as angry and aggressive as she
used to when our treatment sessions began. She is now calm,
lively and happier. Her health is also improving.
Plan
I have found it very useful to involve a marriage counselor
during the therapy to assist because marital issues are beyond
my level. I recommended it to her, and she agreed. Afterwards,
I have helped Amabella get a competent divorce lawyer who has
legally advised her about the whole divorce process as well as
her rights upon leaving the toxic marriage. She agrees to this
for it is good for the safety of the children and her too. The
divorce papers will be ready soon, and she will be moving to
her new apartment in a few days.
Privileged Note
Question
Based on this week’s readings, prepare a privileged
psychotherapy note that you would use to document your
impressions of therapeutic progress/therapy sessions for your
Answer
My client was troubled at the beginning of our sessions. She
disclosed that apart from physical torture from the husband, she
was also sexually abused. In fact, the children know what their
dad was doing to their mother. She was almost reaching her
breaking point, but after completing her therapy, her attitude
has changed. Her being able to open up helped a lot.
The above-privileged note includes vital information about
abuse in Amabella’s marriage. Sensitive issues like rape are
covered, which should be regarded as highly confidential
information which should not be disclosed to any other party.
(Steen, B, 1999,37)
My preceptor uses privileged notes because I prefer to discuss
my issues with him alone because I like my right to privacy to

be respected. If other people know my problems, it would
increase my mental illness.
References
Dick, R, Steen, E (Editors): 1991. The Computer Based Patient
Record; Washington DC, National Academy Press.
723
18
ETHICS IN PSYCHOTHERAPY
NORMAN ABELES AND GERALD P. KOOCHER
In the first 60 years after the founding of the American
Psychological
Association (APA) in 1892, no formal code of ethics existed
(Pope & Vetter,
1992). Not until 1938 did APA establish a Committee on
Scientific and Pro-
fessional Ethics and begin dealing with ethical complaints on an
informal
basis (Golann, 1969). In 1948, development of a formal ethical
code began
under the leadership of Nicholas Hobbs (1948). The first
provisional Ethical
Standards of Psychologists ultimately won adoption by the APA
Council of
Representatives in 1952 for a 3-year trial period (APA, 1953).
The standards originated using a critical incident methodology

(Flanagan,
1954). APA encouraged its members to critique the 1953
publication and
provide additional incidents leading to a vote of the membership
principle by
principle, with formal adoption by the Council to follow in
1955. The APA
has revised its code a number of times in ensuing years, but not
until the 2002
revision did it again use a critical incident survey. In the 5
years leading to
adoption of that revision, APA invited both critiques and case
examples that
did not seem well addressed in prior versions. During that
revision APA
members and the public could submit comments and cases via
the APA web-
site for electronic review by the Ethics Code Revision Task
Force. The APA
http://dx.doi.org/10.1037/12353-048
History of Psychotherapy: Continuity and Change (2nd Ed.),
edited by J. C.
Norcross, G. R. VandenBos, and D. K. Freedheim
Copyright © 2011 American Psychological Association. All
rights reserved.
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approach proved more relevant to actual practice than codes
developed by
other professional associations by virtue of the early reliance on
actual incidents,
and the resulting document became a model for the ethical
codes of other
health professions.
As the practice of psychotherapy bloomed, and as more
psychologists
and other professions entered the field, attention to the unique
ethics of
psychotherapy broadened. Other professional groups added their
own per-
spectives, and the major professions of psychotherapists have
all evolved
distinct ethical codes. These include the American Association
for Marriage
and Family Counseling (2001), American Counseling
Association (2005),
American Psychiatric Association (2006), and National
Association of Social
Workers (1999). Many more specialized psychotherapy ethical
codes exist,
and one can easily locate these via Web searches (Pope, 2008).
An important survey of ethical dilemmas encountered by APA
members
(Pope &Vetter, 1992) yielded categories of ethically troubling
incidents closely

tied to psychotherapy. The prominent categories involved
confidentiality;
blurred, multiple, and/or conflicted relationships; and payment
for services.
Reports of the APA Ethics Committee describing the nature and
incidence
of ethical complaints, published annually in American
Psychologist, suggest
that these three categories remain the most salient bases for
complaints in
psychotherapy practice. In the pages that follow, we trace the
evolution of
these three concerns over the past 6 decades and then consider
controversial
professional and public issues related to psychotherapy.
CONFIDENTIALITY
American history provides many examples of how breaches in
confi-
dentiality of mental health information have hurt both clients
and society.
Thomas Eagleton, a senator from Missouri, was dropped as
George McGovern’s
vice presidential running mate in 1968 following public
disclosure that he
had previously undergone hospitalization for the treatment of
depression.
Dr. Lewis J. Fielding, better known as “Daniel Ellsberg’s
psychiatrist,” certainly
did not suspect that the break-in at his office by federal agents
on September 3,
1971, might ultimately contribute to the only resignation of an
American
president (Morganthau, Lindsay, Michael, & Givens, 1982; G.
R. Stone, 2004).

Disclosures of confidential information received by therapists
also played
prominently in the press during the well-publicized murder
trials of the
Menendez brothers (Scott, 2005) and O. J. Simpson (Hunt,
1999).
No discussion of confidentiality in the mental health arena can
occur
without reference to the Tarasoff case (Tarasoff v. Board of
Regents of the
724 ABELES AND KOOCHER
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University of California, 1976) and the family of so-called
progeny cases that
followed in its wake (see Quattrocchi & Schopp, 2005; A. A.
Stone, 1976;
VandeCreek & Knapp, 2001), as these contributed to significant
changes in
how psychotherapists deal with confidentiality. The case began

in fall 1969,
when a student at the University of California’s Berkeley
campus killed
Ms. Tarasoff, a young woman who had spurned his affections.
The perpetrator
had sought psychotherapy at the university’s student health
facility and gave
his psychologist cause to seek civil commitment by notifying
police about
fears that his client posed a danger to Ms. Tarasoff. The police
concluded that
the patient did not pose a danger and secured a promise that he
would stay
away from Ms. Tarasoff. After his release by the police, the
man understandably
never returned for further psychotherapy, and 2 months later
killed Tarasoff.
California courts determined that the psychologist had a duty to
protect
Ms. Tarasoff and awarded damages. With respect to risk to
public safety,
little hard data exist to demonstrate that warnings effectively
prevent harm,
although reasonable indirect evidence does suggest that
treatment can pre-
vent violence (Douglas & Kropp, 2002; Otto, 2000). Obviously,
ethical prin-
ciples preclude direct empirical validation of management
strategies that may
or may not prevent people at a high risk from doing harm to
others (Koocher
& Keith-Spiegel, 2008).
In addition, many states had already begun passing legislation
mandat-
ing that certain professionals, including psychologists, report

knowledge of
physical or emotional abuse of vulnerable persons (e.g.,
children, older
people, people with disabilities). APA subsequently amended its
Ethics Code
to reflect authorized breaches to prevent imminent harm to self
or others, or
as mandated by law.
In 1996, Congress enacted Public Law 104-191, better known as
the
Health Insurance Portability and Accountability Act or HIPAA.
Regulations
and implementation took several years, but many focus on
protecting the
privacy of personal health information (PHI). HIPAA specifies
that health
care providers, including psychotherapists, must give clients
specific notices
about the confidentiality of records and standards for
authorizing the release
of PHI. It is interesting to note that the APA Ethics Code
already addressed
most of the key principles mandated under HIPAA, albeit with
less specificity
(e.g., the need to alert clients about limits of confidentiality at
the outset of
the professional relationship, releasing information to third
parties only with
a client’s consent). As a result of these cases and statutes,
psychotherapists in
the United States must ethically give all clients information on
the limits of
confidentiality at the outset of a professional relationship and
must breach
confidentiality in certain circumstances to protect the client or

other vulner-
able parties.
ETHICS IN PSYCHOTHERAPY 725
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MULTIPLE RELATIONSHIPS
The APA (2002) “Ethical Principles of Psychologists and Code
of
Conduct” defines multiple role relationships as occurring when
a psychologist
stands in a professional role with a person and also (a) holds
another role
with the same person, (b) has a relationship with someone
closely associated
with or related to the person with whom the psychologist has
the professional
relationship, or (c) makes promises to enter into another
relationship in
the future with the person or a person closely associated with or
related to

the person. One often cannot avoid such role overlap, and the
APA Ethics
Code recognizes this by noting that not all multiple role
relationships with
clients are necessarily unethical so long as no risk of harm can
be reasonably
expected. The code admonishes psychologists to refrain from
entering a
multiple role relationship when their objectivity, competence, or
effectiveness
in performing their professional functions could be impaired or
if a risk of
exploitation exists.
Some mental health professionals decry the concept of
professional
boundaries, asserting that they promote the conduct of
psychotherapy as a
mechanical technique rather than relating to clients as unique
human beings.
Such critics call attention to boundaries’ rigid, cold, and aloof
“cookbook
therapy,” harmful to the natural process of psychotherapy
(Koocher & Keith-
Spiegel, 2008). Lazarus (1994) put it bluntly: “Practitioners
who hide behind
rigid boundaries, whose sense of ethics is uncompromising,
will, in my opinion,
fail to really help many of the clients who are unfortunate
enough to consult
them” (p. 260).
The evolution of strong concern about boundaries appeared
most intensely
in the mid-20th century. As described in Chapter 13a, Jean-
Marc Itard thought

nothing of taking “the wild boy of Aveyron” into his home for
treatment in
1799. In 1914, Sigmund Freud sent his daughter, Anna, on a trip
to England
in the care of one of his patients, Leo Kann. Freud later
conducted the psycho-
analysis of Anna from 1918 to 1922. Anna in turn analyzed Erik
Erikson and
allowed him to travel with the family on vacations so that he
could continue
his treatment. One of the most sensational accounts of multiple
role conflicts
concerns Henry A. Murray (related by his authorized biographer
Forrest
Robinson [1992]). In spring 1925 Murray visited Carl Jung in
Zurich and told
Jung of his infatuation with Christiana Morgan, the wife of a
friend, with whom
Murray would later create the Thematic Apperception Test.
Murray’s story
triggered a self-disclosure by Jung of his intimate relationship
with his patient
Antonia “Toni” Wolff, conducted with the full approval of his
wife, Emma Jung.
At Murray’s urging, Jung agreed to see Christina in October
1925 and encour-
aged her to become Murray’s professional and sexual muse,
while both were
married to other people.
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In the latter part of the 20th century, complaints by patients
alleging
harmful sexual intimacies with psychotherapists became
significant ethical and
professional problems. Increasingly, the field became aware of
how social
and business relationships can compromise the quality of
professional ser-
vices and integrity (Koocher & Keith-Spiegel, 2008). These
factors led to
the founding of the interdisciplinary Neuroethics Society, which
held its
first meeting in November 2008. The society’s president, Steven
Hyman, a
psychiatrist turned neurobiologist and provost of Harvard
University, spoke
on “Neuroethics of Pediatric Bipolar Disorder.” He discussed
the controversy
of assigning the diagnosis of bipolar disorder to hundreds of
thousands of
American children who never before had signs of major mood
disorder, and
simultaneously treating these children with powerful drugs in
off-label usage
(i.e., treatment with drugs neither tested nor approved by the

Food and Drug
Administration for use in children). Other speakers noted the
extremely rare
incidence of the same diagnosis outside of the United States.
As new medications abound, adult diagnoses such as bipolar
disorder
and attendant off-label drug treatments have found their way to
children
as young as 2 or 3 years old. Such medications pose significant
unevaluated
risks for children at young ages. How has this ethically risky
practice evolved?
Recent congressional investigations by Senator Chuck Grassley
(R-Iowa) have
revealed enormous conflicts of interests involving several of the
strongest
proponents of such medical applications. Two Boston Globe
reporters broke
the story of a world-renowned Harvard Medical School
professor and child
psychiatrist at the Massachusetts General Hospital whose work
fueled “an
explosion in the use of powerful antipsychotic medicines in
children,” earning
him at least $1.6 million in consulting fees from pharmaceutical
companies
between 2000 and 2007. The psychiatrist and two of his
colleagues allegedly
never reported much of their income from the drug companies,
estimated at a
combined $4.2 million over 7 years, to university officials
(Harris & Carey, 2008).
The psychiatrists earned much of the money giving continuing
medical
education lectures teaching other physicians about prescribing

such drugs to
children.
Couple these circumstances with long-sought mental health
parity legis-
lation (i.e., granting fiscal parity to coverage of mental
conditions with that
afforded physical conditions), and one sees interesting
contradictions. The
same professionals who support a biopsychosocial model of
emotional problems
willingly adopted enough focus on “illness” to seek insurance
reimbursement
parity (i.e., more money to pay providers). Many psychiatrists,
who have
increasingly eschewed psychotherapy training over
psychopharmacology
practice (Gabbard, 2005), have flocked to incorporate the new
off-label uses
into their practices. Just as others have argued against viewing
psychological
problems as mental illnesses (Szasz, 1960), we now see
economic forces aligning
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to promote remedicalization of such difficulties and even create
new ones to
fit existing or newly created drug protocols (Harris & Carey,
2008). Many
years will pass before one can assess whether these shifting
roles, trends, and
motivations benefit patients or practitioners more.
PAYMENT PROBLEMS
Payment for psychotherapy services has played a significant
role in the
evolution of service delivery. In particular, the advent of health
insurance and
coverage for mental conditions influences who practices
psychotherapy and
how. During the early years of the psychoanalytic movement,
few people
sought or could afford individual therapy, and professional
regulation as we know
it today did not exist. So-called lay analysts abounded. From the
perspective
of psychology, the post–World War II era saw a boom in the
training of
psychologists and struggles with psychiatry over which
profession owned
psychotherapy. The key became insurance reimbursement, as
psychologists
sought licensing recognition, demanded “freedom of choice”
laws, and created
organizations such as the National Register of Health Service

Providers in
Psychology to help secure insurance coverage for their services.
The 1990s
brought managed care and growing ranks of licensed mental
health providers
who needed to account to third parties (i.e., the client and
therapist being the
first and second parties) for their therapeutic decisions and
treatment plans.
Today, newly licensed mental health professionals worry about
their
ability to secure a listing on overcrowded rolls of approved
health insurance
providers. And practice patterns have changed dramatically.
Most younger
psychiatrists have reduced or completely ceased practicing
psychotherapy in
favor of pharmacotherapy (Gabbard, 2005), and licensed
psychotherapists
at the master’s degree level abound. This has led to many
efforts by psycho-
therapists to differentiate themselves with brand-name
psychotherapies,
discussed below, and has led to a host of ethical problems
related to third-
party payments. Some of these concern co-insurance (i.e.,
copayments and
deductibles), billing for missed appointments, and other
potential contract
violations (Koocher & Keith-Spiegel, 2008). The key to ethical
conduct in
financial matters involves carefully informing clients of fees
and other costs
in advance and securing their agreement to these prior to
billing. In addition,

when psychologists sign a contract with a third-party payer,
they must honor
provisions of that contract by such acts as collecting specified
copayments and
not billing clients for amounts in excess of contractual
agreements.
The modern reality involves ethical dealings with clients,
government,
and insurers who have a powerful say in what services they will
pay for and
what data they will demand to process such payments. In every
case, obeying
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contractual agreements, clear communication with clients, and
accurate
billing form the essentials of ethical conduct.
OTHER ETHICAL CHALLENGES IN PSYCHOTHERAPY

Changes in social values also led to changes in the way
psychotherapists
conceptualize their ethical values and practices. Such issues
have included
perceptions of mental illness, same-sex attraction, and the rights
of individuals
to express a preference for rational suicide in cases of painful
terminal illness.
As society has changed, psychotherapists have found themselves
facing situ-
ations and client preferences they could not have envisioned
during their
professional years earlier.
Myth of Mental Illness Debate
In 1960, Thomas Szasz, a psychiatrist, published an article
titled “The
Myth of Mental Illness.” He argued against the medical or
disease model of
mental illness, which presumes that underlying biological
defects can explain
all disorders in thinking and behavior. Szasz differentiated
between physical
symptoms, such as pain or fever, and mental symptoms,
asserting that believing
one’s delusion requires a cognitive judgment. He saw mental
symptoms as tied
to the social and ethical contexts in which they occur.
Szasz objected to claims that any health treatment (including
psycho-
therapy) could ever become value neutral, noting that it is
actually tied closely
to cultural and moral values that one often fails to recognize

explicitly. He
regarded disorders of the brain as falling chiefly under the
rubric of neurology
and insisted that the psychotherapists of the 1960s dealt
primarily with prob-
lems in living, not mental illnesses.
The same year Szasz published his article, O. H. Mowrer
(1960), a former
APA president, published, “‘Sin,’ the Lesser of Two Evils.” He
argued that
troubled people, described as “neurotics,” experience self-
torture and suffer
from excessive rigidity. He suggested that confessing one’s sins
causes the con-
science to loosen its stranglehold, letting society and the
superego relax, and
allowing the person to become free and well. Mowrer’s
assumption: Psychol-
ogists could seek to remedy unacknowledged sin with
psychotherapy.
Suicide Prevention and the Duty to Protect
Ethical principles across mental health professions clearly
emphasize the
importance of protecting clients from harm, including self-
harm. Most mental
health ethics texts (e.g., Koocher & Keith-Spiegel, 2008; Pope
& Vasquez, 2007)
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st
ri
bu
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on
.
devote significant discussion to suicidal risk assessment and
intervention, and
rightly so, because failure to prevent suicide often leads to
complaints against
a deceased patient’s psychotherapist. Thoughtful clinicians will
screen all
clients for suicidal risk during initial contact and remain alert to
possible risks
throughout treatment.
A recent New York Times article (Anderson, 2008) described a
premeditation–passion dichotomy to explain how some
individuals carefully
plan their suicide while others act impulsively using any means
available to
kill themselves. One must consider how people commit suicide
rather than
primarily focusing on why they attempt it. The article cites the
National
Institute of Mental Health (NIMH) as reporting that about 90%
of all com-
pleted U.S. suicides involve people with a diagnosable mental
disorder. It seems
clear that psychotherapists will continue to encounter suicidal

patients and
bear a duty to prevent suicide by comprehensive interventions
involving
psychotherapy and medication, and separating them from the
means of harm-
ing themselves through hospitalization if necessary.
Szasz (1986) pointed out that a director of NIMH had in 1967
described
suicide as a “disease and public health problem” (p. 806) and
reviewed the
resulting difficulties in addressing suicide risk by ethicists, if it
qualifies as a
disease. For example, competent adults have the right to decline
treatment,
even for fatal illnesses. Szasz argued against suicide prevention
(at least coercive
prevention), asserting that the mental state of any potentially
suicidal indi-
vidual has no bearing on instituting coercive action. Szasz did
not object to
helping suicidal patients in psychotherapy but believed that all
people should
assume responsibility for their own behavior unless delirium or
acute psy-
chosis requires physical restraint as an integral part of caring
for that patient
(p. 810). He insisted, however, that the state should not have
the right to pro-
hibit or prevent suicide.
Can rational suicide qualify as a valid quality-of-life decision
requiring
psychotherapists to eschew aggressive intervention? Let’s fast
forward to the
topic of assisted suicide. In 1997, Oregon enacted the Death

With Dignity Act,
allowing patients to obtain prescriptions from physicians to
achieve a humane
and dignified death under specified circumstances (Abeles &
Barlev, 1999).
Under the Oregon law, such patients must not suffer from
impaired judg-
ment and must have a terminal disease. Consider that law in the
context of
a 21-year-old man in Michigan, who had become ventilator
dependent as the
result of quadriplegia (Abeles & Barlev, 1999). Reportedly, he
became depressed
and sought to discontinue using the ventilator knowing that
doing so would
cause his death. He insisted he wanted to die and sought
discharge to home.
His mother agreed with his decision, but the hospital objected.
The courts
allowed his discharge, he returned home, and died following a
visit from
Dr. Kervorkian (Reye, 1998). The courts ruled his death a
homicide.
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py
ri
gh
t
Am
er

on
.
The ethics codes of both the American Psychiatric Association
(2006) and
APA (2002) authorize intervention to prevent suicide. The
National Asso-
ciation of Social Workers (1994), however, provided a position
statement
authorizing nonintervention in jurisdictions where laws permit
assisted suicide.
The debate concerning physician-assisted suicide has increased
since the U.S.
Supreme Court’s holding that physician-assisted suicide remains
a state, rather
than a federal, matter (Gonzales v. Oregon, 2006).
Many professionals (e.g., Werth, 1996) argue that suicide can
constitute
a rational act in some circumstances and present several criteria
to support the
argument. These include the existence of a hopeless condition,
circumstances
in which the decision constitutes a free choice, and clear
indications that the
person has engaged in a sound decision-making process. A
decision of suicide
should include consultation, nonimpulsive consideration of all
alternatives,
and consideration of the impact the act would have on
significant others.
The only existing state law on assisted suicide (Oregon)
requires evaluation
by competent professionals to determine that the patient’s

judgment remains
unimpaired. The APA (2005) report on the role of psychology in
end-of-life
decisions and quality of care identified four roles that
psychologists play in
this area: clinical care, education and training, research, and
policy.
Sexual Orientation Conversion or Reparative Therapy
Sexual orientation conversion therapies, once considered a
treatment
of choice when society deemed homosexuality an illness or
form of psycho-
pathology, raise a number of ethical challenges. For over a
century, medical,
psychotherapeutic, and religious practitioners sought to reverse
unwanted
same-sex attraction or homosexual orientation through a variety
of methods,
including psychoanalysis, prayer, electric shock, nausea-
inducing drugs,
hormone therapy, surgery, and a variety of behavioral
treatments, including
masturbatory reconditioning, visits to prostitutes, and even
excessive bicycle
riding. The American Psychiatric Association’s 1973 decision to
remove homo-
sexuality from its seventh printing of the second edition of the
Diagnostic and
Statistical Manual of Mental Disorders (DSM–II) in 1974
marked the official
demise of the illness model of homosexuality. Despite this
official “depathol-
ogizing” of homosexuality, efforts by both mental health
professionals and

pastoral care providers to convert lesbians and gay men to
heterosexuality
have persisted (Greene, 2007).
Such efforts, variously described as conversion therapy,
reparative therapy,
or therapy to eliminate same-sex attraction, span a variety of
treatments. So-called
reparative therapy emerged in the early 1980s as a “new method
of curing”
homosexuals. Elizabeth Moberly, a conservative British
Christian theologian
with a PhD in experimental psychology, became a key
proponent of the approach
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after publishing her theory “that the homosexual . . . whether
man or woman . . .
has suffered from some deficit in the relationship with the
parent of the same sex;

and that there is a corresponding drive to make good this deficit
. . . through
the medium of same-sex, or ‘homosexual,’ relationships”
(Moberly, 1983, p. 2).
Organizations currently promoting psychotherapy for
individuals with same-
sex attraction often have moralistic or religious underpinnings
and include
the National Association for Research and Therapy of
Homosexuality and
Jews Offering New Alternatives to Homosexuality.
The ethical imperative of respect for clients requires
psychotherapists to
take guidance from and engage clients in goal setting. Some
clients present
themselves for treatment, describing emotional problems
associated with
same-sex attraction. In such circumstances the therapist has an
obligation to
carefully explore how patients arrive at their choices. Some
motives may result
from social pressures or experiences with homophobic
environments. No type
or amount of individual psychotherapy will modify societal
prejudices. In
addition, as part of informed consent to treatment, therapists
must help clients
understand the potential consequences of any treatment,
including those
intended to modify sexual orientation. Clients have a right to
know that repar-
ative treatments lack any validated scientific foundation and
may prove harm-
ful. Finally, clients have the right to know that organizations
representing the

mental health professions do not consider homosexuality a
mental disorder.
Two additional ethical concerns accompany so-called reparative
treat-
ments. First, to what extent does offering such treatments
comport with
therapist responsibility and consumer welfare? Second, given
that rigorous
empirical studies fail to show that conversion therapies work,
do therapists
offering such interventions without clear disclaimers and
cautions mislead
clients (Greene, 2007; Koocher & Keith-Spiegel, 2008)? APA
(1998) addressed
these concerns with a Resolution on Appropriate Therapeutic
Responses to
Sexual Orientation, and similar positions have emanated from
other profes-
sional groups (e.g., American Psychiatric Association, 1998,
2000; National
Association of Social Workers, 2000). These standards
essentially allow ther-
apists to address the stated needs of clients, so long as they
fully inform clients
regarding known limitations.
Teletherapy
Rapid advances in microelectronics have made portable
communication,
data, image, sound storage, and transmission devices affordable
and readily
available in much of the world. A broad array of personal
communications
and business transactions now occur in cyberspace. Mental

health practitioners
increasingly face expectations by clients to provide services in
the context of
their preferred modes of communication. As psychotherapists
move away
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No
t
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on
.
from the traditional context of sitting face-to-face with a client
across a room,
the Greek prefix tele, meaning from a distance, leads naturally
to considering
the ethics of teletherapy. Telehealth is used in medicine and
mental health
for a variety of professional services via telephone and other
electronic means
(e.g., Barnett & Scheetz, 2003; C. B. Fisher & Fried, 2003).
Many medical
specialties have regularly used these techniques for consultation
among
professionals, and a number of services now offer such

consultation directly
to patients for a fee (e.g.,
http://www.eclevelandclinic.org/eCCHome.jsp).
The traditional way of forming alliances and contracts with
individual clients
and professional standards will certainly require rethinking.
From the perspective of professional ethics, consider the four
Cs: contract-
ing, competence, confidentiality, and control (Koocher, 2007).
In the context
of teletherapy, these questions arise: What contracts or
agreements for pro-
viding distance services will we as psychotherapists make with
our clients?
What competencies will we need to offer services remotely?
What new factors
will constrain confidentiality protections? Who will control the
practice of
teletherapy (i.e., the regulation of practice and data access)?
When psychotherapists agree to work with clients via
teletherapy, the
nature and terms of how they relate to clients will change.
Psychotherapists will
need to reach accords on new contracts regarding the nature of
psychological
services and the manner of providing them. For example,
psychotherapists
will have to obtain and document clients’ informed consent to
communicate
with them electronically. Such consent will doubtless require
many changes,
such as establishing reasonable security and encryption
precautions, keeping
information posted on professional websites up to date, and

providing instruc-
tions regarding access and emergency coverage.
Still other questions must be answered: Will we as
psychotherapists
contract to correspond electronically only with existing therapy
clients,
or will we readily accept new referrals of people whom we have
never met
for professional services? Will we agree to conduct assessment,
consultation,
or therapy entirely via telemetry or only a limited range of
services? Will we
promise real-time electronic access 24/7/365? How will record
keeping change,
given the ease with which we can record, store, and alter such
communications?
Will our fees and reimbursement policies differ from office-
based services?
Will we offer emergency coverage? If so, what backup must we
organize for
clients who live hundreds or thousands of miles away?
New standards of care and professional competencies will
certainly apply
when we offer therapy services remotely. APA has not chosen
to address
teletherapy directly in its Ethics Code (APA Ethics Committee,
1997), and
by this intentional omission has created no rules prohibiting
such services.
Telehealth brings the obvious potential for mischief. Those
offering to
provide services and those seeking to obtain them may more
easily engage in

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.
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rt
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on
.
misrepresentation. How can one be certain that the person on
the other end
of the phone line or computer terminal is the person he or she
claims to be?
How accurate are the claims of teletherapy practitioners
regarding their
credentials, skills, and success rates with remote interventions?
How will
therapists feel when an angry former client posts edited excerpts
of their
“sessions” on youtube.com or stupidvideos.com? Will
teletherapy lead to greater
caution and reduced liability (e.g., by reducing the risk of
client–therapist
sexual intimacy) or greater risk (e.g., reduced ability to respond
across dis-
tances with suicidal clients)? We will probably have answers to
such intriguing

questions in the not-so-distant future.
Answers about the control or regulation of teletherapy remain
highly
fluid. Considerable variability exists across licensing
jurisdictions in the United
States with respect to electronic practice across state lines. With
state, provin-
cial, and territorial governments regulating professional practice
within United
States and Canadian jurisdictions, the Association of State and
Provincial
Psychology Boards has taken the lead in attempting to foster
interstate
practice and mobility credentials for psychologists in North
America. How-
ever, little agreement exists regarding standards for interstate or
international
telepractice. When a client in Massachusetts enters teletherapy
with a psycho-
therapist in Michigan, or Mumbai, who regulates the practice?
Does the treat-
ment take place where the client sits, where the therapist sits, or
in cyberspace?
If something goes wrong, to whom can one complain? Will
telepractice qualify
as interstate (or international commerce) exempt from state
licensing author-
ities? We simply do not know the answers at this time.
Brand-Name or Proprietary Psychotherapies
Many psychotherapies have acquired brand-name status over the
years.
Psychoanalysis probably qualifies as the first established brand
of therapy,

even though (as described earlier) the practice of
psychoanalysis today differs
significantly from treatment at Freud’s Vienna Polyclinic (see
Chapter 3, this
volume). We have chosen two different proprietary therapies to
illustrate the
ethical challenges they pose.
Eye Movement Desensitization and Reprocessing.
Eye movement desensitization and reprocessing (EMDR),
developed by
Francine Shapiro (Shapiro, 1995; Shapiro & Forrest, 2004), is
described as a
comprehensive method for treating disturbing experiences such
as trauma
associated with sexual abuse, violence, combat, and grief. The
treatment
incorporates eight stages (using Shapiro’s terminology): taking
the client’s
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.
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.

history and treatment planning, preparation, assessment,
desensitization
and reprocessing, installation of positive cognition, body scan,
closure, and
reevaluation. The treatment asks the client to describe aspects
of traumatic
memories, including recounting mental images associated with
the event, the
client’s emotional and physiological responses, and the negative
feelings of
self contained in the memories The technique repeats the
sequence of steps
until the client’s subjective units of distress scale (so-called
SUDS rating)
approaches zero.
EMDR has become one of the fastest growing treatments in the
annals
of psychotherapy, and its progression has many similarities with
the history
of mesmerism (McNally, 1999). EMDR as a treatment for
posttraumatic
stress disorder has received widely divergent reactions from the
scientific and
professional community. Perkins and Rouanzoin (2002) noted
that many
points of confusion exist in the published literature on EMDR,
including its
theoretical and historical foundation, placebo effects, exposure
procedures,
the eye movement component, treatment fidelity, and outcome
studies. They
described the charges of “pseudoscience” surrounding EMDR
and attributed

the controversy to confusion in the published literature focused
on five factors:
the lack of an empirically validated model capable of
convincingly explain-
ing the effects of EMDR; inaccurate or selective reporting of
research;
some poorly designed studies; inadequate treatment fidelity in
some of the
outcome studies; and multiple biased or inaccurate reviews by a
relatively
small group of authors.
EMDR involves many elements of exposure and cognitive–
behavioral
therapies, along with the lateral eye movements, causing some
to wonder
whether the effective component of EMDR actually qualifies as
new, and
whether the genuinely new aspects of EMDR qualify as
effective (McNally,
1999). Shapiro (personal communication, January 17, 2007)
argued that EMDR
actually integrates many components in addition to cognitive–
behavioral
elements, including those used in psychodynamic and
experiential therapies.
In one book, Shapiro (2002) asked experts of the various
orientations in
experiential, cognitive, and psychodynamic treatment to
identify the elements
in EMDR that made it effective. Each one identified elements of
his or her
own orientation as the pivotal factors.
Reviews of the related eye movement research have provided a
range

of conclusions. Some reviewers (Lohr, Lilienfeld, Tolin, &
Herbert, 1999)
found no compelling evidence that eye movements contribute to
outcome
in EMDR, and the lack of unequivocal findings has led some
reviewers to
dismiss eye movements altogether (e.g., McNally, 1999). Other
reviewers
(e.g., Chemtob et al., 2000; Perkins & Rouanzoin, 2002)
identified method-
ological failings (e.g., lack of statistical power, floor effects)
and called for
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t
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an
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ch
ol
og
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al

A
ss
oc
ia
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on
.
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r
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rt
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r
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.
more rigorous study. Nonetheless, many studies have
demonstrated beneficial
outcomes for some people using EMDR (e.g., Brown & Shapiro,
2006; Konuk
et al., 2006; Raboni, Tufik, & Suchecki, 2006). The Department
of Veterans

Affairs and Department of Defense (2004) listed EMDR as a
potentially
effective treatment in their clinical practice guideline for the
management of
posttraumatic stress.
Although EMDR has clearly proved beneficial for many clients,
its aggres-
sive marketing, early restrictions on teaching, and resulting aura
of secretiveness
have contributed to a sense of mystique and controversy.
Shapiro had attempted
to assure a standard quality in the training of EMDR (Shapiro,
1995; Shapiro
& Forrest, 2004). Proponents founded a nonprofit professional
organization
named EMDR International Association (EMDRIA) as a forum
“where prac-
titioners and researchers seek the highest standards . . . by
promoting training,
research and the sharing of the latest clinical information . . .
assuring that
therapists are knowledgeable and skilled in the methodology”
(according to
its website: http://www.emdria.org/). Sadly, Shapiro’s work has
spawned some
creative imitators with questionable rigor who probably cause
consternation
to well-trained clinicians (Koocher & Keith-Spiegel, 2008).
est
Werner Erhard, the developer of est (Erhard seminar training),
was
a skilled salesman with no professional training as a
psychotherapist. His

program evolved to become the “Forum” seminars (Efran,
Lukens, & Lukens,
1986; Wistow, 1986) and exists currently as the Landmark
Forum, a genre of
so-called large group awareness programs (Finkelstein,
Wenegrat, & Yalom,
1982). The basic approach challenged participants’ sense of
psychological
identity or, as one commentator noted, systematic escalation
and discount-
ing of each participant’s “adapted child,” eventually forcing the
participant
into their “free child” state, thereby releasing a large amount of
“bound
energy” (Klein, 1983, p. 178). Other articles have described est
as brainwashing
(Moss & Hosford, 1983). One of the few careful attempts to
study Erhard’s
techniques in a rigorous fashion showed no long-term treatment
effects and
declared claims of far-reaching effects for programs of the
Forum as exaggerated
(J. D. Fisher et al., 1989).
The ability of skilled salesmen, such as Erhard, to promote and
morph
their programs in the absence of controlled outcome research
and in the
face of criticism by behavioral scientists is quite impressive.
The central
message from an ethical perspective remains the obligation of
therapists
to have a sound scientific foundation for their work. Rigorous
proof of effi-
cacy should precede mass marketing of new techniques to the
public or to

colleagues.
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r

fu
rt
he
r
di
st
ri
bu
ti
on
.
CONCLUSION
In covering the history of ethics in psychotherapy, we have
traversed
the emergence of ethical consensus and code of conduct on
confidentiality,
multiple conflicts, and payment problems. We have selected
contentious
debates and controversies that had raised significant ethical
issues related to
psychotherapy. We have no doubt that changes in the health
care system,
society, and technology will continue to force ethical
reexamination about
the manner in which psychotherapy is practiced.
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1
Comprehensive Client Family Assessment
Demographic Information
Date of assessment: 09/14/2018.
DOB: 011/01/1970.
Age: 48.
Race: Black.
SSN: 000000001. Ethnicity: African American.
Address: On file. Tel: 972-000-0000.
Residential Status: Homeless.
County: 9K. Military Status: None.
Language: English.
Interpreter Needed: No.
Primary Insurance: Uninsured.
Annual Gross Income: $0.
Employment Status: Unemployed.
Number of people in the household: 1.
Highest Grade: 11.
School Attendance for the past 3 Months: None.

Arrival Time: 1000 Time Disposition Completed: 1100
Location of client: Lake Worth Nursing Home
Presenting Problem
“My meds are not working.”
History of Present Illness
Association, 2013).
Past psychiatric history
features
Medical history
None Reported
Substance use history
Alcohol Abuse: began drinking at age 15 and drinks 8 to 10
bottles of beer daily, yesterday was his last time he drank.
Developmental history
None Reported
Family psychiatric history

Positive for family history of mental illness on the paternal
side.
Psychosocial history
The patient is unemployed and enjoys hanging out with fellow
drunkards on the street with drinks, a living condition currently
unstable as the patient is homeless.
History of abuse/trauma
The patient suffered abuse paternal uncle at age 12.
Review of systems
General: significant weight gain recently, positive with fatigue,
but no fever or a cough.
HEENT: vision and hearing changes not reported at this time,
no history of glaucoma, cataracts, diplopia, floaters, excessive
tearing or photophobia, last eye exam four years ago. No ear
infections, tinnitus or discharges in the ear, have no problems
with smell, and taste. Denies epistaxis or nasal drainage, no any
loose teeth, mouth sores or bleeding gum when brushing teeth.
No difficulty with chewing or swallowing.
Neck: positive for JVD, no bruits
Respiratory: Denies shortness of breath, labored breathing,
cough, but could be exposed to TB.
Cardiovascular: S1 and S2, RRR. No Shortness of breath
reported, denies chest pain, palpitations, No difficulty during
exercise.
GI: No nausea, vomiting, heartburn, indigestion. No changes in

bowel/bladder pattern, bowel sounds present on all four
quadrants.
GU: No change in urinary pattern, hematuria or dysuria.
Musculoskeletal: WNL, No joint pain or swelling.
Psych: Positive for the history of mental health, reports anxiety,
depression suicidal ideation but no homicidal thoughts.
Neuro: Alert, oriented x 3, no fainting, dizziness, or loss of
coordination, positive for weakness.
Skin: warm to touch and moist, denies any skin changes, rashes
or raised lesions, no itching, no history of skin disorders or
cancers, no swelling.
Hematologic: No bleeding disorders or clotting issues, no
history of anemia or blood transfusions.
Allergic/Immunologic: Penicillin- rash and seasonal allergies,
Sulfa drugs - rash.
Physical assessment
Vital signs: B/P 130/78; P 70 regular; T 98.4 orally; RR 20 non-
labored; RBS 100mgdl; Wt: 140 lbs.; Ht: 5’6; BMI 22.6.
Mental status exam
The level of consciousness: cerebral perfusion, coherent
thought, concise responses.
Mood: Depressed and sad.
Behavior: Appropriate/Normal and cooperative.
Cognition: displays signs of hallucination and compulsion.
Personal hygiene and grooming: deteriorated grooming and
personal hygiene.
Memory and attention: AO x 3.

Differential diagnosis
features
4- Recurrent Episode with psychotic features (DSM-5, 2018).
Columbia Suicide Severity Rating Scale:
1- Wish to be dead: Yes
2- Suicidal thoughts: yes
3- Suicidal thoughts with method (with a specific plan and
intend to act): Yes
4- Suicidal Intend (with particular plan): Yes
5- Suicidal Intend with a specific plan; Yes
6- Suicidal behavior question: Yes
If yes to 6, how long ago did you do any of these: Over a year
ago (American Psychiatric Association, 2013).
Case formulation

Association, 2013).
Treatment plan
The client will begin an antidepressant Sertraline (Zoloft) 25
mg PO daily for the next four week and monitor progress. Start
patient on an alcohol detox program to help with dependency
and encourage to client join the alcohol anonymous (AA) group
for support (Wheeler, K., 2014).
Assignment Instructions. Please read carefully to the end before
starting
Assignment 2: Practicum – Assessing Client Progress
To prepare:
· Reflect on the client you selected for the Week 3(See the
attached case study for client selected in week 3) Practicum
Assignment.
· Review the Cameron and Turtle-Song (2002) article in this
week’s Learning Resources for guidance on writing case notes
using the SOAP format (See attached resource).
The Assignment
Part 1: Progress Note
Using the client from your Week 3 Assignment, address the
following in a progress note (without violating HIPAA
regulations): (See sample paper)
Treatment modality used and efficacy of approach
Progress and/or lack of progress toward the mutually agreed-
upon client goals (reference the Treatment plan—progress
toward goals)
Modification(s) of the treatment plan that were made based on

progress/lack of progress
Clinical impressions regarding diagnosis and/or symptoms
Relevant psychosocial information or changes from original
assessment (i.e., marriage, separation/divorce, new
relationships, move to a new house/apartment, change of job,
etc.)
Safety issues
Clinical emergencies/actions taken
Medications used by the patient (even if the nurse
psychotherapist was not the one prescribing them)
Treatment compliance/lack of compliance
Clinical consultations
Collaboration with other professionals (i.e., phone consultations
with physicians, psychiatrists, marriage/family therapists, etc.)
Therapist’s recommendations, including whether the client
agreed to the recommendations
Referrals made/reasons for making referrals
Termination/issues that are relevant to the termination process
(i.e., client informed of loss of insurance or refusal of insurance
company to pay for continued sessions)
Issues related to consent and/or informed consent for treatment
Information concerning child abuse, and/or elder or dependent
adult abuse, including documentation as to where the abuse was

reported
Information reflecting the therapist’s exercise of clinical
judgment
Note: Be sure to exclude any information that should not be
found in a discoverable progress note.
Part 2: Privileged Note
Based on this week’s readings, prepare a privileged
psychotherapy note that you would use to document your
impressions of therapeutic progress/therapy sessions for your
client from the Week 3 Practicum Assignment.
The privileged note should include items that you would not
typically include in a note as part of the clinical record.
Explain why the items you included in the privileged note
would not be included in the client’s progress note.
Explain whether your preceptor uses privileged notes, and if so,
describe the type of information he or she might include. If not,
explain why.
References
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced
practice psychiatric nurse: A how-to guide for evidence-based
practice (2nd ed.). New York, NY: Springer Publishing
Company.
· Chapter 5, “Supportive and Psychodynamic Psychotherapy”
(pp. 238–242)
· Chapter 9, “Interpersonal Psychotherapy” (pp. 347–368)
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington,
DC: Author.
Note: You will access this text from the Walden Library
databases.

Abeles, N., & Koocher, G. P. (2011). Ethics in psychotherapy.
In J. C. Norcross, G. R. VandenBos, D. K. Freedheim, J. C.
Norcross, G. R. VandenBos, & D. K. Freedheim (Eds.), History
of psychotherapy: Continuity and change (pp. 723–740).
Washington, DC: American Psychological Association.
doi:10.1037/12353-048
Note: You will access this resource from the Walden Library
databases.
Cameron, S., & Turtle-Song, I. (2002). Learning to write case
notes using the SOAP format. Journal of Counseling and
Development, 80(3), 286–292. Retrieved from the Academic
Search Complete database. (Accession No. 7164780)
Note: You will access this article from the Walden Library
databases.
Nicholson, R. (2002). The dilemma of psychotherapy notes and
HIPAA. Journal of AHIMA, 73(2), 38–39. Retrieved from
http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4http://lib
rary.ahima.org/doc?oid=58162#.V5J0__krLZ4
U.S. Department of Health & Human Services. (n.d.). HIPAA
privacy rule and sharing information related to mental health.
Retrieved from http://www.hhs.gov/hipaa/for-
professionals/special-topics/mental-health/
Required Media
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013).
Counseling and psychotherapy theories in context and practice
[Video file]. Mill Valley, CA: Psychotherapy.net.

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