Table of Contents
Introduction
Chapter 1 The Therapist’s Personal Belief System
Personal Frame of Reference
Internal Reality, Clinical Safety, and Protecting the Clinician
The Complexity of Making Safe Legal and Ethical Decisions
Potential Loss of Objectivity
Clinical Example # 1
Questions for Clinical Example # 1
Chapter Questions
Chapter 2 Informed Consent
Informed Consent and the Therapeutic Contract
Informed Consent and Case Law
Legally-Required Elements of Informed Consent
Ethical Therapeutic Duty to Obtain Informed Consent
Therapeutic Contract, Part I: The Therapy Process
Therapeutic Contract, Part II: The Client’s Rights
Therapeutic Contract, Part III: Fees and Length of Therapy
Therapeutic Contract, Part IV: Consent for Treatment
Therapeutic Contract, Part V: Office Policies
Informing Clients of the Potential Risks and Benefits of Therapy
Clinical Example
Informed Consent When Using “Challenging” Therapies
Hugging and Psychotherapy
Informed Consent and Touching Therapies
Touch Therapies and Touching Violations
Steps to Help Prevent an Accusation of a Boundary Violation
Termination and Standard of Care
Managing Termination Safely
Reasonable and Prudent Steps to Take When Terminating Difficult and Uncooperative Clients
Sudden Termination of Therapeutic Services
Termination and CAMFT Ethical Standards
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Clinical Example # 3
Questions for Clinical Example # 3
Chapter Questions
Chapter 3 Confidentiality
Confidentiality
Mandated Breaches of Confidentiality
Permitted Breaches of Confidentiality
Written Releases of Information
Sample of a Release of Information Document
Releasing Outpatient Psychotherapy Records for Diagnosis and Treatment Only
Group Therapy
“Holding Information” Policy (Secrets): and It’s Clinical Implications
How the “Holding Information” Policy Affects Treatment and The Therapeutic Relationship
Minors and Confidentiality
Minors and Privilege
Safeguarding Sensitive Clinical Information Involving Minors From Insurance Companies
Electronic Devices
The Internet
Fax Machines
Fax Warnings
Sample Fax Warnings
HIV Status
Confidentiality & Mandated Reporting
Making a Decision to Report or Not Report a Legally-Mandated Breach of Confidentiality
Documenting the Decision to Report or Not Report a Legally-Mandated Breach of Confidentiality
Confidentiality Challenges: Employees and Volunteers
Confidentiality Challenges With Ex-Associates, Ex-Interns, and Ex-Trainees
Potential Breaches of Confidentiality in Settings With Multiple Clinicians
Other CAMFT Ethical Standards Related to Confidentiality
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Clinical Example # 3
Questions for Clinical Example # 3
Clinical Example # 4 61
Questions for Clinical Example # 4
Chapter Questions
Chapter 4 Privilege
Privilege
Evidence Code 1010-1027
Exemptions to Privilege
Clinical Example # 1
Questions for Clinical Example # 1
Chapter Questions
Chapter 5 Important Legal Concepts in MFT Practice.
Scope of Practice
Scope of Competence
CAMFT Ethical Standards Related to Scope of Competence and Integrity
Therapeutic Duty
Some Clinical Examples of Therapeutic Duty
Therapeutic Duty Regarding Assessing Appropriately
Therapeutic Duty Regarding Diagnosing Appropriately
Therapeutic Duty Regarding Treating Appropriately
Collaborating With Others
Standard of Care
Attending to Standard of Care in Clinical Practice
The Clinicians Therapeutic Duty to Assess for Clinically Important Issues Thoroughly and Completely
Mental Health Case Law
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 6 Business and Professions Code as it Applies to Marriage and Family Therapists SECTIONS 4980–4989
Business and Professions Code
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Clinical Example # 3
Questions for Clinical Example # 3
Chapter Questions
Chapter 7 Malpractice and Unprofessional Conduct
Malpractice
Unprofessional Conduct
Creating Therapeutic Safety: Learning the Hard Way
Mental Health Records and Lawsuits: A Direct Correlation
How Small Clinical Issues Become Malpractice or BBS Administrative Actions
How Attorneys Develop Malpractice Cases Against Clinicians in Conjunction With an Expert Witness
A Malpractice Action Arising For Reporting as Well As Nor Reporting Child Abuse
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 8 The Therapeutic Relationship
The Therapeutic Relationship
CAMFT Ethical Standards Related to the Therapeutic Relationship
Protecting the Therapeutic Relationship
Using the Therapeutic Relationship Appropriately
Injuring the Therapeutic Relationship
The Power Differential of the Therapeutic Relationship
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 9 Dual Relationships
Dual Relationships
Harmful Dual Relationships
Friendships With Clients
Sexuality and Clients
Civil and Criminal Actions Specific to Sexual Boundary Violations
Mandated Brochure “Therapy Never Includes Sex”
Administrative Actions by the BBS
Sexual Harassment: A Workplace Hazard for MFTs
Testifying On Behalf of Clients Can Create a Harmful Dual Relationship
Subtle Dual Relationships
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Clinical Example # 3
Questions for Clinical Example # 3
Chapter Questions
Chapter 10 Managing Crisis Issues and Protecting the Clinician
The Danger for Clinicians When Managing Crisis Issues
The Clinician’s Scope of Competence Regarding Crisis Issues
Reasonable and Prudent Steps Required To Manage Crisis Issues
Assessing the Client’s Competence
Initial Assessment of the Client
Consultation With Past and Current Treatment Providers
Observable Clinical Behavior
Psychosocial Stressors and Environmental Problems
Culturally Sensitive Clients
Assessing For Risk Factors
Establishing An Appropriate 5-Axis Diagnosis
The Presenting Crisis Issue
The Emergency “Plan of Action” To Manage Crisis Issues
Applicable California Laws in Managing Crisis and High Risk Issues
CAMFT Ethical Standards and Crisis Issues
Braching Confidentiality in a Safe Manner
Hospitalization as a Clinical Intervention
Post-hospitalization Risk Factors
Suicide-Specific Laws and Codes: Managing This Issue
Serious Threat to Harm an Identifiable Victim (Tarasoff Situation)-Specific Laws and Codes: Managing This Issue
Spousal Abuse-Specific Laws and Codes: Managing This Issue
Child Abuse-Specific Laws and Codes: Managing This Issue
Elder and Dependent Abuse-Specific Laws and Codes: Managing This Issue
HIV-Positive Clients-Specific Laws and Codes: Managing This Issue
Eating Disorders-Specific Laws and Codes: Managing This Issue
Substance Abuse/Dependence to the Degree Where the Client is a Danger to Self or Others-Specific Laws and Codes: Managing This Issue
Documenting Intake Information
Documenting A Mental Status Exam
Sample Mental Status Exam
Documenting a Beck Depression Inventory
Documenting Consultations
Documenting Treatment Plans for Crisis Issues
Documenting a 5-Axis Diagnosis
Documenting the Legal Challenge
Legal/Ethical Documentation Examples
Clinical Example # 1
Questions for Clinical Example # 1
Chapter Questions
Chapter 11 The Suicidal Client and Standard of Care
The Suicidal Client
Legal, Ethical, and Clinical Standards of Care for Treating Suicidal Clients
Reasonable and Prudent Steps to Manage Suicidality
Permitted Breaches of Confidentiality Under Evidence Code 1024
Clinical Example # 1
Questions for Clinical Example # 1
Chapter Questions
Chapter 12 The Dangerous Client in a Tarasoff Situatio
The Dangerous Client
Dangerous Clients and Laws Affecting Psychotherapists
Civil Code 43.92
Ewing v. Goldstein
Clinical Applications Under Ewing v. Goldstein
Calderon v. Glick (2005), Ca. App. 4th
Managing “Serious Threat to Harm”
Clinical Example # 1
Questions for Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 13 Mandated Child Abuse Reporting
Child Abuse
Managing Child Abuse Reporting
Reporting Child Abuse Involving Adults Abused as Children
Employees and Child Abuse Law
Child Abuse Reporting and Immunity
The Use of Anatomically Correct Dolls to Prove Child Abuse
Reporting Consensual Sex Between Minors
Reporting Consensual Sex Between Minors and Adults
The Confidentiality Bind in Child Abuse Reporting
The Child Abuse Laws—Penal Code 11164-11174.3
Child Abuse Report
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Clinical Example # 3
Questions for Clinical Example # 3
Chapter Questions
Chapter 14 Elder and Dependent Abuse
Management of Elder and Dependent Abuse
Employees and Elder/Dependent Abuse Laws
Elder and Dependent Abuse Reporting and Immunity for MFTs
Recent Changes to the Elder/Dependent Abuse Laws
The Elder and Dependent Abuse Laws: Welfare and Institutions Code Section 15600-15755
Elder/Dependent Abuse Report
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 15 Mental Health Records
Mental Health Records and Psychotherapy
Mental Health Records: The Law and Ethical Standards
Health and Safety Code 123130 — The Foundation for the Content of Mental Health Records
The Clinical Foundation for Content of Mental Health Records
Patient Access to His/Her Mental Health Records
Computerized Records
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 16 The Content of Mental Health Records
Appropriate Content of Mental Health Records
Intake Form
Informed Consent Form
Additional Informed Consent
Ledger Form
Psychometric Testing
Written Releases of Information
5-Axis Diagnosis, Treatment Plan, and Prognosis
Consultation and Medical Information
Progress Notes
Discharge Summary
Chapter Questions
Chapter 17 Sample Clinical Forms
Sample Intake Form
Sample Informed Consent Form
Sample Ledger Form
Sample Mental Status Exam Form
Sample Release of Information Form
Sample Diagnosis, Treatment Plan, and Prognosis Form
Sample Consultation Form
Sample Progress Form
Sample Discharge Summary
Chapter 18 Writing Case Notes
A Repeatable Format
Documenting Scope of Practice
Documenting Diagnosis
Consultations and Referrals
Writing Progress Notes
Documenting Legal Issues and Challenges
Treatment Plans as Assessment and Documentation Tools
The Appropriate Use of Treatment Plans
Writing Discharge Summaries
Clinical Charting for Hospital Cases
Chapter 19 Subpoenas
Subpoenas
Managing Subpoenas
Document 1: Actual Subpoena
Document 2: Notice to Consumer
Document 3: Proof of Service
Document 4: Declaration of Records Released
Clinical Example # 1
Questions for Clinical Example # 1
Chapter Questions
Chapter 20 Supervision of Trainees and Interns
Supervision Issues
Dual Relationship with Interns and Trainees
Interns and Trainees as Employees
Additional Requirements for Interns and Trainees
Advertising
Supervisor’s Responsibilities
The Supervisee’s Dual Relationship With a Client Can Affect the Clinical Supervisor
Contractual Agreements
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 21 Advertising
Advertising
Fictitious Names and Yellow Pages
Advertising and Interns/Trainees
Specialty Practice
Other Ethical Standards Defining Advertising
Referral Services
Clinical Example # 1
Questions for Clinical Example # 1
Chapter Questions
Chapter 22 Fees
Fees
Bartering
Disclosure of Fees
Non-Affordability of Fees
Collecting Unpaid Balances
Maintaining Clinical Objectivity With Third Party Payers
Serious Challenges Faced By Clinicians When Third Parties Pay For Clinical Services
Ethical Guidelines Regarding Fees
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Clinical Example # 3
Questions for Clinical Example # 3
Chapter Questions
Chapter 23 Insurance and Managed Care
Insurance and Confidentiality
Insurance Fraud
Ethical Standards Regarding Insurance Fraud
Appealing Adverse Utilization Review Decisions in Managed Care
Confidentiality and the Internet 327
Reasonable and Prudent Actions To Take Before Clients Run Out of Insurance Benefits
Clinical Example # 1
Questions for Clinical Example # 1
Chapter Questions
Chapter 24 Forensics, Telephone and Online Counseling
Expert Witness
Child Custody Evaluations
Personal Injury Evaluations
Psychometric Testing
Criminal Forensic Assessments
CAMFT Ethical Standards Related to Forensic Activities
Telephone and Online Counseling
Witness of Fact Versus an Expert Witness
Business and Professions Code 805
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 25 Cultural Diversity
Cultural Diversity and Psychotherapy
Therapeutic Duty and Cultural Diversity: Example — The Mexican-American Client
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 26 Treatment of Minors, Family Law
Treatment of Minors With Parental Consent
Treatment of Minors Without Parental Consent
Treatment of Emancipated Minors
Treatment of Minors in Divorce Situations
Drug and Alcohol Counseling Treatment for Minors
Holding Information Policy and Minors
Minors and Releasing Sensitive Clinical Information to Third Party Payers
Family Code
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Chapter Questions
Chapter 27 Clinical Challenges With Legal Implications
Clinical Objectivity: The Foundation of Making Clinical Decisions
The Risks and Benefits of Keeping Minimal vs. Voluminous Records
Clinicians Ignore Risk Factors At Their Own Risk
The Out of Compliance and Uncooperative Client
The impaired Clinician and His or her Immediate Colleagues
The “It Will Never Happen to Me” Syndrome
Working and Collaborating With Unlicensed Mental Health Clinicians
Closing an Office and Avoiding Harm to Clients
The Clinician’s Malpractice Experience
Chapter 28 CAMFT Ethical Standard 1 - Responsibility to Patients
1.0 Responsibility to Patients
1.1 Non-Discrimination
1.2 Dual Relationships: Definitions
1.2.1 Unethical Dual Relationships
1.2.2 Sexual Contact
1.2.3 Prior Sexual Relationships
1.3 Treatment Disruptions
1.3.1 Termination
1.3.2 Abandonment
1.3.3 Financial Gain
1.3.4 Non-Payment of Fees
1.4 Patient Autonomy
1.4.1 Electronic Therapy
1.5 Therapist Disclosures
1.5.1 Risks and Benefits
1.5.2 Emergencies/Contact Between Sessions
1.5.3 Consent for Recording Observations
1.5.4 Limits of Confidentiality
1.5.5 Therapist Background
1.6 Exploitation
1.7 Patient Benefit
1.8 Employment and Contractual Terminations
1.9 Family Units/Conflicts
1.10 Withholding Records/Non-Payment
1.11 Consultations
1.12 Advocate With Third-Party Payers
1.13 Treatment Alternatives
1.14 Potential Conflicts
1.15 Documenting Treatment Decisions
1.16 Non-Therapist Roles
1.17 Third Party Payer Disclosures
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Clinical Example # 3
Questions for Clinical Example # 3
Clinical Example # 4
Questions for Clinical Example # 4
Clinical Example # 5
Questions for Clinical Example # 5
Chapter Questions
Chapter 29 CAMFT Ethical Standard 2 - Confidentiality
2.0 Confidentiality
2.1 Disclosure of Confidential Information
2.2 Signed Authorizations – Release of Information
2.3 Electronic Media
2.4 Maintenance of Patient Records – Confidentiality
2.5 Employees – Confidentiality
2.6 Use of Clinical Materials – Confidentiality
2.7 Group – Confidentiality
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2
Clinical Example # 3
Questions for Clinical Example # 3
Chapter Questions
Chapter 30 CAMFT Ethical Standard 3 - Professional Competence and Integrity
3.0 Professional Competence and Integrity
3.1 Conviction of a Crime
3.2 Financial Incentives
3.3 Clinical Records
3.4 Professional Assistance
3.5 Staying Current
3.6 Cultural Sensitivity
3.7 Therapist Cultural Values
3.8 Harassment or Exploitation
3.9 Scope of Competence
3.10 Patient Seeing Two Therapists
3.11 Electronic Services
3.12 Research Findings
3.13 Public Statements
3.14 Limits of Professional Opinions
Clinical Example # 1
Questions for Clinical Example # 1
Clinical Example # 2
Questions for Clinical Example # 2