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Ethics COMP Exam William James College Cheat Sheet (DRAFT) by

Ethics comprehensive exam william james college cheat sheet

This is a draft cheat sheet. It is a work in progress and is not finished yet.


We have a moral respon­sib­ility to protect research partic­ipants from harm.
Training Standards (CACREP- Council for Accred­itation of Counseling and Related Education Programs) – course work, content of courses, hours
State Licensing Boards – baseline requir­ements for course work, field placement hours, superv­ision, formal mechanism of redress for ethical violations
Profes­sional codes of ethics become yardsticks to judge approp­riate behavior.
Reporting Requir­ements in ethics codes may not align with state laws or regula­tions
When a practi­tioner has a license they are not competent to work with all popula­tions
When therapist extend the boundaries of their practices, or when they branch out onto an area requiring specialty compet­ence, they should seek consul­tation with a competent practi­tioner
Those who are respon­sible for educating and training mental health profes­sionals are ethically and profes­sio­nally obligated to balance their roles as advocate and mentor of trainees with their gateke­eping role


Duty, Privacy, and Confid­ent­iality
Fiduciary Relati­onship a profes­sional relati­onship in which the profes­sional providing the service commits to acting in the best interest and needs of the client (not our own).
Standard of Care profes­sional conduct that is “consi­stent with the degree of learning, skill, and ethics ordinarily possessed and expected by reputable counselors practicing under similar circum­stances
Ethical standards (codes) can be used by a court to determine whether a profes­sional operated within the standard of care for his/her profession
Privilege (or Testim­onial Privilege) legal term that refers to the protection of confid­ential commun­ication in the context of a legal proceeding Client “Waive the privilege” Therapist “Invoke the privilege”
Referring a client for differing religious beliefs, sexual orient­ation, or cultural background is a discri­min­atory referral
Privacy: the consti­tut­ional right of an individual to be left alone and to control his or her personal inform­ation
Vicarious liability: the respon­sib­ilities superv­isors have to oversee the actions of their superv­isees

Types of Law

Crimin­al/­Penal Law prosecuted by the government (not indivi­duals)
Civil Law (civil rights of indivi­duals) Torts wrongful acts by one individual against another: battery, defama­tion, invasion of privacy (breach of confid­ent­iality) - malpra­ctice (due to neglig­ence)
Civil commitment emergency mental health treatment
Admini­str­ative Law created by govern­mental admini­str­ative agencies that develop regula­tions to define laws and are passed by Congress or state legisl­ative body (HIPPA)
monetary compen­sation typically awarded for damage

Ethical Decisi­on-­Making Model

1. Identify the Problem, 2. Examine the relevant ethics codes, laws, and regula­tions
3. Consider the values of our profession
4. Consider all potential factors that may influence your decision
5. Consult with a trusted colleague, superv­isor, and/or expert
6. Pause – attend to your emotions
7. Enumerate the conseq­uences of your decision
8. Involve your client in decisi­on-­making process (when possible)
9. Make decision, 10. Implement decision

Termin­ation and Referral by ACA A11

Cannot abandon client, if unable to assist client, refer elsewhere
Termin­ation may be from Intense value conflicts or counte­rtr­ans­ference resulting in loss of object­ivity, Incomp­etence in area of treatment focus
Termin­ation if client is not improving, provide pre-te­rmi­nation counseling and refer elsewhere when indicated
Approp­riate transfer of care; commun­icate with new provid­er(­s)/­bridge sessions
Termin­ation and referrals should not be made impuls­ively – seek consul­tation and document
Value Conflicts If we referred every client who is different or difficult, we’d never gain experience working with diversity
If you are having a pattern of value conflicts, may need to consul­t/r­efe­r/t­erm­inate


Subpoena request for records Court Order issued by judge(must comply!)
Transf­erence clients reactions to therapist based on previous important relati­ons­hips; these reactions can take the form of intens­eth­oug­hts­/fe­eli­ngs­/at­tit­ude­s/f­ant­asi­es/­beh­aviors
Counte­rtr­ans­ference therap­ists’ reactions to clients

Liability for Civil Damages

Failing to diagnose or predict danger­ous­ness, Failing to warn potential victims of violent behavior
Failing to commit dangerous indivi­duals, Premat­urely discha­rging dangerous clients from a hospital

Laws & Mental Health Profession

Laws or Statutes behaviors that will be allowed and minimum standards that will be tolerated in society (black­/white)
Legisl­atures US Congress federal laws Mass General Court state laws
State laws: state licensure laws that govern how and under what circum­stances we can practice (i.e., state reporting laws; duty to warn)
Local (munic­ipal) laws determine where counseling can occur - zoning
Federal laws: HIPAA, Americans with Disabi­lities Act (ADA); Family Educat­ional Rights and Privacy Act (FERPA)
HIPAA: covered entities must comply Covered entities: health plans, health care cleari­ngh­ouses, health care providers. Applies to transm­ission of EHR.
HIPPA: client has rights to change, restrict, amend, and access PHI
Regula­tions legisl­atures delegate power to admini­str­ative agencies to develop standards. These agencies add detail and issue guidelines to clarify law
Case Law judicial decisions based on a case from a court; involves an interp­ret­ation or reinte­rpr­etation of a law that becomes precedent Tarasoff cases
Ethics Codes standards set by the profession that govern profes­sional conduct
Standards of HIPAA: 1.Privacy requir­ements 2.Elec­tronic transa­ctions 3.Security requir­ements 4.National identifier requir­ements
Tarasoff v. Regents of the University of California: The California court's ruling that requires therapists to breach confid­ent­iality in cases in which the general welfare and safety of others is involved
Jaffee v. Redmond the Supreme Court ruled that commun­ica­tions between licensed psycho­the­rapist and their clients are privileged and therefore protected from forced disclosure in cases arising under federal law

American Legal Justice System

US Consti­tution (Supreme law; no law can conflict) - tripartite government a. Legisl­ative(creates law) b. Executive(enforces law) c. Judicial(inter­prets law)
Laws passed by Congress (federal level - impacts US as a whole) or state legisl­ative body (impacts Common­wealth of MA), Federal Consti­tution sets a minimum bar

Various Mental Health Codes of Ethics

ACA code of ethics (2005), APA Ethical principles of psycho­logists and code of conduct (2002), Code of Ethics of the American Mental Health Counselors Associ­ation (2000)
NASW code of ethics (1999), The principles of medical ethics with annota­tions especially applicable to psychiatry (2006), Ethical standards for school counselors (2004), American Associ­ation for Marriage and Family Therapy Code of Ethics

Various Ethical Stances

Prescr­iptive Ethics “specific guidelines that clearly demarcate ethical respon­sib­ilities that could be used by the ACA Ethics Committee in adjudi­cation of ethical violat­ions”
Aspira­tional Ethics “create a document that helps profes­sionals aspire to a higher level of ethical thought, reflection and practice”
Principle Ethics: focus is on obliga­tions, morality, and “right” action
Virtue Ethics focuses on ideals and the character of the profes­sional Assessing the client problem(s)
Normative Ethics: acting in compliance with the law and following minimal ethical standards

Ethical Themes

Do good, Avoid harm or exploi­tation, Confid­ent­iality, Act respon­sibly
Conduct must be guided by what is in the best interest of our clients
Promote welfare of the client, Practice within one’s area of compet­ence, Uphold the integrity of the profession

Purpose of Ethics

Safeguard the welfare of clients, Protect the public, Clarify our values, Catalyst for improving practice
Educate profes­sionals about ethical practice / means of establ­ishing standards of care
Avoid ethical conundrums guide ethical behavior when problems arise
Provide a means of formal monitoring (profe­ssional accoun­tab­ility
Obligation to self monitor our behavior and encourage ethical behavior of colleagues
Identify unethical conduct point toward need for governing body (licensing board or profes­sional organi­zation) to evaluate conduct and “weed out” unethical providers

Ethics Codes vs Laws

Ethics standards set by the profession that govern profes­sional conduct (often murky) – Represent ideal standards set and enforced by profes­sional associ­ations
Laws rules set by the state/­gov­ernment re: behaviors that will be allowed (define the minimum standards that will be tolerated in a society) (black­/white)
Regula­tions standards developed by experts in the field that are adopted as rules and enforced like laws –State licensing laws determine the scope of practice of profes­sionals and how these laws will be enforced by licensing boards

Principles & Virtues of Profession

Nonmal­efi­cence Do No Harm (Hippo­cra­tes), Benefi­cence (benef­iting others)
Respect Autonomy & Self-D­ete­rmi­nation: the promotion of self-d­ete­rmi­nation and the freedom of clients to be self-g­ove­rning within their social and cultural framework
Discer­nment or Prudence (exercise caution, deliberate reflec­tion, tolerance for ambiguity, do not act impuls­ively)
Integrity (honest; whole) Justice (be fair and consis­tent), Fidelity (be faithful; honor commit­ments), Veracity (be truthful)
Accord Dignity, Treat Others with Caring and Compas­sion, Pursue Excell­ence, Be Accoun­table, Be Courageous

Record Keeping for follow-up contact (Zur, 2015)

a. Date of service and duration of session
b. Type of service rendered (indiv­idual, couple, family, group)
c. Nature of profes­sional interv­ention or contact (treatment modali­ties, e-mail, phone contact)
d. Current status (mental status, change in symptoms, high-risk concerns)
e. Gifts from clients, therap­ists, or others, loans of books or CDS, and bartering arrang­ements
f. Extensive use of touch or self-d­isc­losure, g. Recording or videot­aping of sessions, h. Dual relati­onship (nature, extent, etc.)
i. Out-of­-office experi­ences (e.g., home visits, attending weddin­gs/­fun­erals, attending a medical appoin­tment with client, clinically meaningful incide­nta­l/c­hance encoun­ters, etc.)
j. Client respon­ses­/re­actions to interv­ent­ions, k. Current risk factors, l. Additional treatment modalities (medicine, hypnosis), m. Plans for future interv­ent­ions, n. Qualit­ative aspects of therap­eutic relati­onship, o. Prognosis
p. Assessment of summary data, q. Consul­tations with other profes­sio­nals, r. Case-r­elated contacts – phone, email, mail, s. Cultural and sociop­oli­tical variables
t. Any ethical decisi­on-­making process, u. Contacts made with collateral providers or family member­s/loved ones, v. All consul­tations
w. Termin­ati­on/­Tra­nsfer Note – why patient left treatment, circum­stances around termin­ation, and any other pertinent info such as post-t­herapy recomm­end­ations or transfer of care

Ethics and Diversity

Encaps­ulated: viewing the world through a specific culturally bound lens. A cross-­cul­tural counselor who perceives reality exclus­ively through the filters of their own life experi­ences
Stereotype beliefs: a widely held, simpli­fied, and essent­ialist belief about a specific group.
Bruff vs. North Missis­sippi Health Services, Inc. involved in employee assistance program provider who refused to counsel homosexual clients on the basis of religious beliefs and was eventually terminated by her employer
Uninte­ntional racism: claiming to be free of any traces of racism
The ethics codes of the ACA, the APA, and the NASW clearly state that discri­min­ation on the basis of sexual orient­ation is unethical and unacce­ptable.
It is important to understand that homose­xuality and bisexu­ality are not indicative of mental illness.
Therapists have an ethical obligation to confront their personal prejud­ices, myths, fears, and stereo­types regarding sexual orient­ation.
People with chronic medical, physical, and mental disabi­lities represent the largest minority and disadv­antaged group in the United States
Social justice: the fair and equitable distri­bution of power, resources, and obliga­tions in society to all people, regardless of race, gender, ability, status, sexual orient­ation, and religious or spiritual background


Hidden agenda are seen as material that should be brought out into the open during a couples or family session.
Therapists should inform clients that any inform­ation given during private sessions will be divulged as they see fit in accordance with the greatest benefit to the family.
Therapists should not divulge in a family session any inform­ation given to them by indivi­duals in private sessions.
Many believe it is wise to have a no secrets policy
Fisher’s (2008) 6-step ethical practice model: 1.Prep­aration 2.Tell clients the truth “up front” 3.Obtain truly informed consent before making a disclosure 4.Respond ethically to legal requests for disclosure 5.Avoid the “avoid­able” breaches of confid­ent­iality 6.Talk about confid­ent­iality

Beginning With Clients

Essential piece of inform­ation the family practi­tioner must provide before each individual agrees to partic­ipate in family therapy: Risks of negative outcomes and positive benefits and confid­ent­iality and limits to confid­ent­iality, The purpose of therapy, what can be expected, and the option to withdraw at any time, Typical proced­ures, rights and respon­sib­ili­ties, and fee structure

Ethical Issues & Consid­era­tions

Clinicians agree that conducting couples therapy while there is ongoing domestic violence presents a potential danger to the abused and is unethical
Developing a multiple or dual relati­onship: consider whether the potential benefits outweighs the potential for harm
A client wants to give a counselor a gift: be aware that accepting the gift may be culturally approp­riate with this client
A common reaction of therapist who realize that they have sexual feelings towards their clients is to: feel guilty, anxious and confused
certain actions will inevitably lead to a progre­ssive deteri­oration of ethical behavior is the slippery slope phenomenon
While practicing in Massac­hus­etts, you receive a request for records from a former client: do not charge
Under Massac­husetts General Law (MGL) chapter 122 section 12F, certain minors who are considered to be mature due to certain statuses, can provide consent without guardian approval in the cases of, the minor is: a member of the armed force, married, widowed, or divorced, a parent themselves
mental health profes­sionals are expected to exercise 'reaso­nable care' in working with clients who are consid­ering abortion. If they fail to do so, clients can take legal action against them for negligence
Because providing counseling services over the Internet (aka remote or distance counse­ling) is relatively new and contro­ver­sial, a host of legal questions will NOT be addressed until lawsuits are filed pertaining to its use, or misuse, counseling practice
Malpra­ctice claims are not reserved exclus­ively for the irresp­onsible practi­tioner. Clients may make allega­tions of unethical conduct or file a legal claim to neglig­ence, even though the counselor may have acted ethically and approp­ria­tely. To succeed in a malpra­ctice claim, the plaintiff needs to show that a breach of duty did exist in which the practi­tioner failed to provide the approp­riate standard of care
A counselor working in an AIDS-related case has a few legal guidelines to help determine when or how to inform potential victim of the threat of HIV transm­ission

Group Work

When partic­ipation in a group is part of a counseling master's program, safeguards must be in place to manage boundaries and reduce the risk of harm to students, The safeguards include informed consent of students, systematic instructor self-r­efl­ection, self-d­isc­losure training
Group leaders have a respon­sib­ility to: explain its import­ance, inform members of the diffic­ulties involved in enforcing it, clearly define what it means and its limits
As a rule, group leaders should conduct only those type of groups for which they have been trained
Training for counselors working with groups: Learning about ethical decision making regarding dilemmas encoun­tered in group work, Personal (indiv­idual) psycho­the­rapy, Personal experience in a self-e­xpl­oration group, Becoming involved in supervised experi­ences
The final (termi­nation) phase of group work may be the one that leaders handle most ineptly.
Groups remain a powerful interv­ention tool across the life span, positively impacting childhood, adult and geriatric disorders
Questions that needs to be pondered when screening prospe­ctive group members: It is approp­riate for this person to become a partic­ipant in this type of group, with this leader, at this time?
Orienting group members to the group experience before it begins: explore the members' expect­ations, clarify goals and object­ives, discuss procedural details, explore the possible risks and values of group partic­ipation and discuss guidelines for getting the most from a group experience
The ethical, legal, and profes­sional aspects of confid­ent­iality have a different applic­ation in group situations
Implic­ations of group members and their therapist commun­icating with each other online, and when group members commun­icate with other members via the internet: lack of techno­logical skills and knowledge to protect inform­ation that is intended to remain private creates a risk of making this inform­ation public for all to see, increased risk of breach of privacy, increased risk of breach of confid­ent­iality