Is it Ethics or Law?

Is it Ethics or Law?

In my position as chair of the Florida Psychological Association’s Ethics Committee, I frequently receive telephone calls from psychologists asking for guidance about ethical concerns. However, the majority of questions I hear actually have nothing to do with ethics, per se. Rather, they are queries about the law and psychologists often seem surprised to find that they are blending the two realms in their minds. I’ll try to clarify how to tell if a dilemma is ethics or law in this column.

Laws are rules of conduct established by a community or authority and enforceable by that entity. The underlying philosophy of the law is called jurisprudence. Certainly, it may be claimed that ethical concerns are often at the root of our laws, but ethics do not carry the power of law. In order for laws to have real meaning, a system of punishments is often established and enforced. In the United States, laws are established and enforced by federal, state, county and local governments.

Psychology’s ethical system is promulgated by The American Psychological Association. APA’s current Code of Ethics was adopted by the Council of Representatives and establishes our ethical guideposts. As stated in the code’s introduction, “The Ethics Code is intended to provide guidance for psychologists and standards of professional conduct that can be applied by the APA and by other bodies that choose to adopt them.”

What follows is 16 pages of “guidance” covering many of the ethical challenges with which psychologists must wrestle on a daily basis. The code is, quite literally, the end product of decades of work by thousands of psychologists who committed their time and energy to carefully considering the relevant issues. However, the code is not law and specifically addresses that point in its introduction by stating:

“The Ethics Code is not intended to be a basis of civil liability. Whether a psychologist has violated the Ethics Code standards does not by itself determine whether the psychologist is legally liable in a court action, whether a contract is enforceable, or whether other legal consequences occur.”

The code provides further clarification in section 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority: “If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict. If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority.”

Ultimately, therefore, we may obey a law that conflicts with our ethical code. However, if our ethical obligations represent a higher moral standard than the law, we are obligated to embrace that higher level. And, we are bound to consider a variety of sources of guidance, including that found in our own conscience.

The instructions continue: “In the process of making decisions regarding their professional behavior, psychologists must consider this Ethics Code in addition to applicable laws and psychology board regulations. In applying the Ethics Code to their professional work, psychologists may consider other materials and guidelines that have been adopted or endorsed by scientific and professional psychological organizations and the dictates of their own conscience, as well as consult with others within the field. If this Ethics Code establishes a higher standard of conduct than is required by law, psychologists must meet the higher standard.”

We are required to engage in a “process” that can be complex and not always satisfying. An example of this process may be briefly discussed relative to laws requiring psychologists to report child abuse.

What is to be done if a nearly 18 year-old patient tells you that he was abused by his stepmother when he was 12? He has had no contact with his stepmother for five years since his father divorced her and she moved to New Zealand. Therapeutically, is it in the patient’s best interests to report the abuse? If not, our ethical standards would suggest that it not be done. However, the law requires it.

Therefore, law trumps ethics. However, your consultation with peers and a personal examination of conscience may ultimately lead you to consider not making the report. Yet, to not report the incident is a violation of the law. What do you do?

Nobody said it was going to be easy.

By Stephen A. Ragusea, PsyD, ABPP

This article is one of 28 included in the 3-hour online continuing education course Ethics & Risk Management: Expert Tips 8 that addresses a wide variety of ethics and risk management topics, written by experts in the field.

Related Online Continuing Education (CE) Courses:

Ethics & Boundaries in PsychotherapyEthics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE) course intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. Course #30-77 | 2017 | 42 pages | 21 posttest questions

*This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs. It also includes teachings from the 2014 ACA Code of Ethics to meet the ethics requirement of West Virginia counselors.

Ethics and Law in Florida PsychologyEthics and Law in Florida Psychology is a 3-hour online continuing education (CE) course that meets the ethics and law requirement for license renewal of Florida psychologists. The purpose of this course is to ensure that Florida-licensed psychologists are fully aware of the ethical and legal privileges and constraints under which they are licensed to practice in the State of Florida. It provides the opportunity for a comprehensive reading of the APA Code of Ethics and the three sets of statutes and rules governing the practice of psychology in Florida. Completing this course will fulfill the requirement that licensed psychologists in Florida complete each biennial renewal period three hours of continuing education on professional ethics and Florida statutes and rules affecting the practice of psychology. Case examples are included in this course for the purpose of illustrating the types of practices errors that occur in real life and their real consequences for clients. They are actual cases found in the official public records of the Florida Department of Health Division of Medical Quality Assurance. Licensing board complaints are a matter of public record. Nevertheless, the case reports outlined are included only for the purpose of illustrating the kinds of errors that occur in the practice of psychology and therefore contain no specifics like names, dates, or case numbers. Course #31-05 | 2018 | 55 pages | 20 posttest questions

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Speech-Language Pathologists (SLPs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

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Florida Domestic Violence CE Requirement

Domestic Violence CE Available @pdresources.org

The Florida Statutes require that Florida-licensed healthcare professionals complete a 2-hour continuing education course on domestic violence every third biennial relicensure period.

The course shall consist of information on the number of patients in that professional’s practice who are likely to be victims of domestic violence and the number who are likely to be perpetrators of domestic violence, screening procedures for determining whether a patient has any history of being either a victim or a perpetrator of domestic violence, and instruction on how to provide such patients with information on, or how to refer such patients to, resources in the local community, such as domestic violence centers and other advocacy groups, that provide legal aid, shelter, victim counseling, batterer counseling, or child protection services.

Professional Development Resources offers such a course to meet this requirement:

Domestic ViolenceDomestic Violence: Child Abuse and Intimate Partner Violence is a 2-hour online continuing education (CE) course intended to help healthcare professionals maintain a high state of vigilance and to be well prepared with immediate and appropriate responses when abuse is disclosed.

Domestic violence, in the form of child abuse and intimate partner violence, remains a pervasive part of contemporary life in the U.S. Its effects are deep and far-reaching. This course will teach clinicians to detect abuse when they see it, screen for the particulars, and respond with definitive assistance in safety planning, community referrals, and individualized treatment plans. There is a special section on the complexity of an abuse victim’s decision about if and when to leave an abuser. This course meets the Domestic Violence license renewal requirement of all Florida licensees. Course #21-12 | 2016 | 42 pages | 15 posttest questions

Click here to learn more.

Related Courses:

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document).

Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more. Have a question? Contact us. We’re here to help!

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Speech-Language Pathologists (SLPs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

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Why Therapists Need Ethics

By Claire Dorotik-Nana, LMFT @pdresources.org

EthicsThere is a good reason that ethics is a required component of our continuing education for license renewal. Ethics alone can be grounds for losing your license. It can also be grounds for a lawsuit. And more often than not, it is the source of client harm – even when it is not meant to be.

A therapist who means well but doesn’t fully understand client privilege or confidentiality can harm a client just as much as therapist who simply ignores ethical protocol. Today, with the explosion of social media, it has become even more difficult to decipher the difference. For example, let’s say a therapist runs groups for a treatment facility and happens to post on Facebook about a particularly challenging group session, tagging her workplace in her post. While one could argue that she meant no harm, she has exposed the identity of the clients in the group because she identified the facility in which she works.

This becomes even more important because today many therapists work in a variety of capacities – even virtually. Let’s say, for example, that a therapist becomes well known in a particular subject area and is now asked to give radio interviews about his subject matter. What is the ethical protocol here? Or, perhaps the same therapist is asked to create webinars on his area of expertise. Can he reference places that he has worked in the past? Can he mention clients he has worked with if he alters their names? What if he is asked to write a book on the subject? What ethical measures should he take then?

Ethics, as you can see, is no less important to the seasoned therapist than the new one, and in many ways, it is actually more important. With more experience comes more opportunity and with more opportunity comes more risk.

This is risk that can easily be avoided with a thorough understanding of ethics that are relevant to today’s therapist. Through learning about topics such as managing negative online reviews, taking on supervisees, being asked to write letters for clients who seek to have Emotional Service Animals, conducting group treatment, managing a social media profile, creating cloud storage for notes, purchasing liability insurance, correcting records, closing a practice, giving professional commentary on public figures, and doing media presentations, therapists can enjoy a wide variety of working capacities in a safe and ethical way.

So where do therapists go to find this information? Professional Development Resources, an accredited provider of online continuing education courses, offers ethics courses for psychologists, counselors, social workers, marriage and family therapists (MFTs), occupational therapists (OTs), speech-language pathologists (SLPs), and registered dietitians (RDs). Click here to learn more.

Online Ethics Continuing Education Courses:

Ethics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE) course intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. *This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs. It also include teachings from the 2014 ACA Code of Ethics to meet the ethics requirement of West Virginia counselors. Course #30-77 | 2017 | 42 pages | 21 posttest questions

Ethics and Social Media is a 2-hour online continuing education (CE) course that examines the use of Social Networking Services (SNS) on both our personal and professional lives. Is it useful or appropriate (or ethical or therapeutic) for a therapist and a client to share the kinds of information that are routinely posted on SNS like Facebook, Twitter, and others? How are psychotherapists to handle “Friending” requests from clients? What are the threats to confidentiality and therapeutic boundaries that are posed by the use of social media sites, texts, or tweets in therapist-client communication? The purpose of this course is to offer psychotherapists the opportunity to examine their practices in regard to the use of social networking services in their professional relationships and communications. Included are ethics topics such as privacy and confidentiality, boundaries and multiple relationships, competence, the phenomenon of friending, informed consent, and record keeping. A final section offers recommendations and resources for the ethical use of social networking and the development of a practice social media policy. Course #20-75 | 2016 | 32 pages | 15 posttest questions

Ethics for Speech-Language Pathology and Audiology is a 2-hour online continuing education (CE/CEU) course that presents an overview of ethical issues that arise in speech-language pathology and audiology practice. Speech-language pathologists (SLPs) and audiologists encounter ethical issues across the spectrum of practice settings, from pediatric treatment to care of elders in skilled nursing facilities. This course will discuss barriers to ethical thinking, evidence-based ethics, economics, discrimination, abuse, bullying in the workplace, boundaries, confidentiality, social media, and infection control. Course #21-04 | 2015 | 30 pages | 15 posttest questions

Ethics for Occupational Therapists is a 3-hour online continuing education (CE/CEU) course that teaches OTs how to handle ethical and moral dilemmas in practice. Ethical and moral issues pervade our lives, especially in the healthcare arena. Occupational therapists are frequently confronted with a variety of ethical and moral dilemmas, and their decisions can have long-range effects both professionally and personally. Why does one decision win out over another? What does the decision process involve? How do these decisions impact those involved? Occupational therapists, by the nature of choosing this particular profession, are engaged in an “ethic of care,” where activities of daily living are not just a function, but also an expression of values. Helping people maintain their maximum possible functioning is seen in relation to society and the common good of all persons. This is an abstract ideal that must be put into practice in an imperfect world. How does the occupational therapist make decisions about what is best for the person when there are difficult choices to make? This course will address these questions from the framework of ethical decision models and the American Occupational Therapy Association’s Code of Ethics. Course #30-89 | 2016 | 43 pages | 20 posttest questions

Ethics for Registered Dietitian Nutritionists is a 1-hour online continuing education (CE/CEU/CPEU) course that addresses the ethics of practice in nutrition and dietetics and satisfies the requirement of the Commission on Dietetic Registration that RDs and DTRs complete a minimum of 1 CPEU of Continuing Professional Education in Ethics (Learning Need Code 1050) during each 5-year recertification cycle. The practice and business of nutrition and dietetics grow and change but ethical practices remain paramount regardless. Potential situations arise that require a review of what the ethical solution(s) should be. This course includes real-life scenarios so you can utilize the profession’s Code of Ethics to identify these ethical issues and come up with solutions and ways to avoid unethical behaviors. Course #10-60 | 2014 | 10 pages | 7 posttest questions

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Virginia Counselors License Renewal & CE Info

Virginia Counselors Save 20% on CE @pdresources.org

Virginia Licensed Professional Counselors (LPCs) have an upcoming license renewal deadline of June 30, 2017. All LPCs who wish to renew are required to have completed a minimum of 20 hours of continuing competency for each annual licensure renewal. A minimum of two of these hours shall be in courses that emphasize the ethics, standards of practice or laws governing behavioral science professions in Virginia.

Virginia Board Of Counseling 
CE Required: 20 hours per year
Online CE Allowed: No limit
License Expiration: 6/30, annually
National Accreditation Accepted: APA, NBCC
Notes: 2 hrs in ethics, standards of practice, or laws governing behavioral science professions in Virginia required each renewal
Date of Info: 5/11/2017

Virginia counselors can earn all 20 hours required for renewal through APA/NBCC-approved online courses offered @pdresources.org. Order now and save 20% on ALL courses:

Click to Save 20% on CE!

Click here to view NBCC-approved online CE courses.

Professional Development Resources has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5590. Programs that do not qualify for NBCC credit are clearly identified. Professional Development Resources is solely responsible for all aspects of the programs.

Ethics & Boundaries in PsychotherapyEthics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE) course intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. Course #30-77 | 2017 | 42 pages | 21 posttest questions

This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs. It also include teachings from the 2014 ACA Code of Ethics to meet the ethics requirement of West Virginia counselors.

Gender Identity and TransgenderismGender Identity and Transgenderism is a 3-hour online continuing education (CE) course that reviews issues in the formation of gender identity and the possible resultant condition of transgenderism, formerly transsexuality. After viewing oneself as a human being, the most important aspect of our self-concept is that we are a male person or a female person. That is the very essence of our humanness and the most basic sense of who we are. To experience a conflict between our physical body and our concept of maleness or femaleness is the most fundamental existential distress imaginable. This course will discuss the ongoing distinction between sex and gender, causes and prevalence of transgenderism, harassment of transgender children, DSM-5 diagnostic criteria, theories of gender development, conversion therapy, modern medical and socio-psychological treatment of transgender patients, passing, and postsurgical relationships and therapy. Certain prominent transgenderists are discussed, and several autobiographies are referenced to further our understanding of the complex transgender life experiences. Finally, some examples of positive changes are presented, which increase the knowledge base for the professionals who see transgender patients in their practices, along with other nascent societal changes, which, in turn, can improve these patient’s lives. Course #30-91 | 2016 | 41 pages | 20 posttest questions

Counseling the Pastor's KidCounseling the Pastor’s Kid (PK) is a 3-hour online continuing education (CE) course that will provide clinicians with an understanding of the complex factors that cause stress in PKs, along with recommendations for prevention and treatment. It has been long observed that the ministry is one of the most frustrating and stressful working professions, due largely to the complex dynamics that exist between clergy and their congregations. Among the consequences of these pervasive stressors are high levels of chronic anxiety, depression, and burnout. What has received less focus and commentary is the plight of many of the children of these clergy – the “pastor’s kids.” Known in the vernacular as “PKs,” these children and adolescents are exposed to many of the same chronic stressors that take such a toll on their clergy parents. The differences are that the children (1) did not voluntary enter the ministry, (2) are not developmentally prepared to cope with complex adult stressors, and (3) do not have the opportunity to develop a sense of self free from the constraints of intense social pressure. The goal and purpose of this course is to enable readers to understand the issues and stresses of a clergy family and how they affect the children in these families. It is likely that most mental health professionals will encounter clergy – and their children – among the clients they treat in their practices. The course is divided into two parts. Part one focuses on the specific challenges PKs face growing up. These challenges fall into seven specific areas: 1) behavioral expectations imposed upon the child by family, church congregations, peers and self; 2) stereotypes imposed upon the child through psychological, sociological, and anthropological influences; 3) life experiences that are universally perceived by PKs as negative; 4) spiritual development; 5) blurring of parental boundaries; 6) psychosocial issues; and 7) coping mechanisms employed by the PK. The second part focuses on 1) using Bowen’s Family Systems Theory as a basis for assessment and treatment of the PK and the family; 2) illustrating the use of a genogram as a viable tool in understanding multigenerational processes; and 3) suggestions for counselors and parents. Course #30-93 | 2017 | 45 pages | 20 posttest questions

Over 100 online courses are available @pdresources.org.

Online courses provide instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more.

 

Dual or Multiple Relationships in Psychotherapy

Course excerpt from Ethics & Boundaries in Psychotherapy

Dual RelationshipDual relationships (Zur, 2014) refer to situations where two or more connections exist between a therapist and a client. Examples of dual relationships are when a client is also a student, friend, employee or business associate of the therapist. Zur defines many types of dual relationships, including social, professional, business, communal, institutional, forensic, supervisory, sexual, and digital, online, or internet dual relationships. While all dual relationships involve boundary crossing, exploitive dual relationships are boundary violations.

Multiple relationships are situations in which a therapist is engaged in “one or more additional relationships with a client in addition to the treatment relationship. Multiple relationships may be sexual or nonsexual. Nonsexual multiple relationships may include social, familial, business or financial relationships, and possibly others. Multiple relationships are distinguished from incidental contacts. Incidental contacts are situations in which the psychologist and client have an interaction in another setting that is unplanned and very brief. Examples may include noticing that the psychologist and client are attending the same concert or community event, being members of the same organization, or briefly crossing paths in the community” (Barnett, 2014).

For many psychologists practicing in rural and small communities, dual relationships are everyday occurrences. The person who bags groceries in the supermarket, pumps gas, works in a dentist’s office or chaperones children on school field trips may often also be the therapist’s client.

Unavoidable dual relationships are also the norm within numerous small populations in larger metropolitan areas, such as gay/lesbian, handicapped, various minorities, religious congregations and other such distinct small societies. In fact, duality, mutual dependence and prior knowledge of each other are prerequisites for the development of trust and respect in these communities.

Zur (2005) goes further in expressing the idea that “rigid avoidance of all boundary crossings and dual relationships raise two major concerns: First, I am concerned that rigid implementation of such boundaries decreases therapeutic effectiveness. Second, as exploitation as a rule happens in isolation, I am concerned that the isolation imposed by rigid boundaries increases the likelihood of exploitation of, and harm to, clients. Rigid boundaries in fact increase the therapist’s power and, therefore, increase the chance of a client being exploited.”

Epstein & Simon (1992) developed an “Exploitation Index” for clinicians to use to evaluate their own boundary maintenance. Some areas which require self-awareness and watchfulness by one’s supervisors or consultants are:

• Obvious therapist distress or upset
• Therapeutic drift — shifting style and approach to a given client
• Lack of goals and reflection on progress in therapy
• Therapy which exceeds normal length for a client of that type in the particular therapist’s practice
• Exceeding areas of competence, reluctance or unwillingness to refer for other types of therapy, assessment, etc.
• Unwise techniques such as hugs or excessive touch
• Becoming enmeshed in client’s life — treating close friends or family members
• Unique vulnerabilities like attraction to or over-identification with client

Multiple relationships are addressed in most professional codes of ethics. For example, the AAMFT Code of Ethics addresses the issue in Article 1.3:

Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client’s immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions.

The NASW Code of Ethics describes multiple relationships (“dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively”) and addresses them in Article 1.06 (c):

Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries.

Several other dimensions are added by the APA Code of Ethics Article 3.05 Multiple Relationships, which expands the concept to include relationships with individuals who are associated or related to clients:

(a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

In summary, it seems clear that multiple relationships are of interest in the ethics codes of most major professional organizations. Are they innately hazardous for client and therapist? Not necessarily. Are they cause for ethical alertness and introspection? Yes.

Ethics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE/CEU) course intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. * This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs. Course #30-77 | 2015 | 40 pages | 21 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

Sexual Misconduct in Psychotherapy

Course excerpt from Ethics & Boundaries in Psychotherapy

Sexual Misconduct in PsychotherapyAccording to Barnett (2014), it is widely accepted that psychotherapists experience feelings of sexual attraction toward clients and engage in sexual fantasies about clients (Pope, Tabachnick, & Keith-Spiegel, 1987; Pope, Sonne, & Greene, 2006). This is a naturally occurring phenomenon that exists whether or not it is acknowledged and appropriately addressed. In fact, Pope, Tabachnick, and Keith-Spiegel (1986) found that 87% of psychotherapists they surveyed acknowledged having been sexually attracted to one or more clients.

Sexual misconduct within the context of psychotherapy represents one of the most egregious forms of boundary violation. It consists of “explicitly adding a sexual component to the professional relationship, regardless of who might have initiated it” (Nagy, 2011, p. 38). It has a high risk of harming the client and is always prohibited within professional relationships.

The devastating effects to psychotherapy clients, who are, by definition, in a vulnerable position, have been widely documented. According to Pope and Vasquez (2011, p. 211), the consequences for clients who have been sexually involved with a therapist tend to cluster into 10 very general categories:

1. Ambivalence
2. Guilt
3. Emptiness and isolation
4. Sexual confusion
5. Impaired ability to trust
6. Confused roles and boundaries
7. Emotional lability
8. Suppressed rage
9. Increased suicide risk
10. Cognitive dysfunction, frequently in the areas of concentration and memory and often involving flashbacks, intrusive thoughts, unbidden images, and nightmares

In an earlier classic national survey of psychologists, Pope and Vetter (1991) studied the characteristics of patients who had engaged in sexual intimacies with a therapist. The following are selected statistics from that study:

• 32% of the patients had experienced incest or other child sex abuse
• 20% of the patients were seen pro bono or for a reduced fee
• 14% of the patients attempted suicide
• 1% (7 patients) committed suicide
• 11% of the patients required hospitalization considered to be at least partially a result of the intimacies
• 12% of the patients filed formal complaints, such as licensing board complaints or malpractice suits

These statistics bring to light the extensive damage that is done to patients by psychotherapists who engage in this form of boundary violation. Among the most notable are the observations that nearly one-third of the patients in this survey were among the most vulnerable of client groups: those who were victims of child sex abuse; a large number (134 patients) attempted suicide; only 12% eventually filed formal complaints.

In view of the documented damage sustained by clients, it is not surprising that nearly all professional organizations and at least half the states have legal prohibitions against sexual relationships in psychotherapy.

It is important that each therapist become familiar with the state statutes that cover violations of this well-known prohibition against patient-therapist sexual relationships.

Many states proclaim a blanket prohibition against sexual activity between therapist and patient in any of the three situations:

1. While in therapy
2. Within two years of a normal termination
3. By means of “therapeutic deception.” – Therapeutic deception means the use of coercion to coax a client into inappropriate sexual behavior (i.e., I can only help you if you let me massage you).

Ethics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE/CEU) course intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. * This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs. Course #30-77 | 2015 | 40 pages | 21 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

Florida Counselors, Social Workers & MFTs – License Renewal & CE Information

By Gina Ulery

Florida-licensed Mental Health Counselors, Clinical Social Workers and Marriage & Family Therapists (MFTs) have an upcoming license renewal deadline of March 31, 2015.

Online Continuing Education30 hours of continuing education (CE) are required to renew, including:

2 hours Preventing Medical Errors in Behavioral Health is required each renewal
3 hours Ethics & Boundaries in Psychotherapy is required each renewal
2 hours Domestic Violence is required every third renewal
3 hours Florida Laws and Rules is required every third renewal

Professional Development Resources is approved by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); and the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) to offer continuing education courses to counselors, social workers and MFTs and is CE Broker compliant (all courses are reported within 1 week of completion).

Florida-licensed counselors, social workers and MFTs can earn all 30 hours required for renewal through online courses available @ www.pdresources.org.

 

Common and Not-So-Common Ethical Considerations

Course excerpt from Ethics & Boundaries in Psychotherapy

In the everyday practice of psychotherapy, professional therapists may regularly expect to encounter a number of ethical dilemmas, some of them commonplace and routine, others more exotic and challenging. Among the challenges that have come about more recently are the ethics and boundary issue that accompany the use of social media. Psychotherapists probably make numerous ethical decisions every day, frequently without any awareness they are doing so. With years of experience, such decisions may become reflexive responses, requiring little – if any – deliberation.

Examples of these “garden variety” ethical issues may be questions like these:

  • You want to present your client with the opportunity to give informed consent for the treatment you are about to deliver. How do you assure that you include all of the relevant issues, and that the client understands and is competent to give such consent?
  • A grateful client brings you a gift. Do you accept it and thank her, do you explain that you do not accept gifts from clients, or do you choose some other ethical course of action?
  • You encounter a client in a social situation. In consideration of his right to privacy and confidentiality, do you approach him in a friendly manner or do you wait for him to take (or not take) the initiative?
  • You receive an invitation on your professional LinkedIn page from a current client who has googled you and wishes to communicate via this medium. Does a digital connection constitute an inappropriate multiple relationship?
  • You find that the husband in a couple you have been treating in marital therapy is the new minister in your church. Do you find another church, discontinue therapy with the couple, or consider some other course of action?
  • You have a client who is moving out of the state, and she asks you to continue treating her via Skype sessions until she can connect with a new therapist. What are the ethical ramifications of engaging in teletherapy?
  • A client tells you in a therapy session that another therapist in town has become socially involved with your client’s friend, whom that therapist was recently treating. Do you report this activity to the state licensing board, confront the other therapist, or choose some other course of action?

Of course, even the most mundane situations can quickly become highly complex ethical dilemmas that demand considerable thought and possibly even consultation with a peer or supervisor. For example, the issue of gift-giving can represent an emotionally charged transference transaction, requiring the therapist to respond with great sensitivity. In negotiating such a complex interchange, the therapist may have to walk a thin line between maintaining appropriate professional boundaries and acknowledging important transference issues.

Ethics & Boundaries in PsychotherapyIssues that come up infrequently, are highly complex or unusual, those the therapist has rarely or never encountered before, and those that pose ethical dilemmas may require some thought, research, consultation, or all three of these. The “Patriot Act” scenario introduced above may fall into this category. It is an example of a novel situation that throws complex contradictions into a boundary issue that may have been more straightforward before the introduction of this piece of legislation. Not only is it novel, but it is also likely to arouse conflicting values in the therapist. How does one simultaneously 1) observe the letter and spirit of the law, 2) protect the client’s right to privacy and confidentiality, 3) fulfill the ethical obligation of informing the client when demands have been made for private records, 4) conform to the ethical standards set forth by his or her profession’s code of ethics, and 5) satisfy personal values and boundaries?

Other issues that may pose more complex boundary challenges are situations in which there either is no clear ethical solution or in which there are multiple paths available to the therapist, all of which contain some ethical complications. Here is one example:

You have been seeing a married couple for relationship therapy for several months. They decide to divorce, and both request to continue to see you individually. You have a good therapeutic relationship with both of them, and both are in significant distress. Can you see them both without encountering boundary issues that might compromise the individual best interests of each; do you choose one or the other; or do you decline to treat either one of them?

In this scenario, if the available courses of action include seeing both, neither, or only one of the partners, all of these seem to involve some possible hazards and ethical questions. If you provide individual sessions to both partners, can you offer the kind of unequivocal support each deserves when there are adversarial issues to be resolved? Can you offer genuine impartiality when you are aware of the details of both partners’ agendas? On the other hand, if you choose to continue treating one or the other, or decline to treat either, aren’t there potential issues of abandonment?

Ethics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE/CEU) course intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. * This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs. Course #30-77 | 2015 | 40 pages | 21 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

 

Ethics & Boundaries in Psychotherapy – New CE Course

By Leo Christie, PhD

Ethics & Boundaries in PsychotherapyEthics & Boundaries in Psychotherapy is a new online continuing education (CE/CEU) course that is intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. Course #30-77 | 2015 | 40 pages | 21 posttest questions

* This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs.

CE Credit: 3 Hours
Target Audience: Psychologists | Counselors | Social Workers | Marriage & Family Therapists
Learning Level: Intermediate
Course Type: Online

This online course provides instant access to the course materials (PDF download) and CE test. Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. You can print the test (download test from My Courses tab of your account after purchasing) and mark your answers on while reading the course document. Then submit online when ready to receive credit.

CE Information:

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

About the Author:

Leo Christie, PhD, LMFT, is a Florida-licensed Marriage and Family Therapist with a doctorate in Marriage and Family Therapy from Florida State University. Past President of the Florida Council on Family Relations, Dr. Christie is currently CEO of Professional Development Resources, a nonprofit corporation whose mission is to deliver continuing education credit courses to healthcare professionals throughout the United States. He has more than 20 years experience in private practice with a specialty in child behavior disorders and as an instructor for over 500 live continuing education seminars for healthcare professionals.