1
Q
Scope of Practice
A
What state laws allow you to do legally with an MFT license.
2
Q
Scope of Competence
A
Based on your specific education, what you are trained to do, and experience.
i.e. Do not treat outside your scope of competence without training and/or supervision.
3
Q
Professional Misconduct
A
Unprofessional conduct that refers to actions taken in a professional role that are below minimum professional standards.
Examples include: conviction of a felony, misdemeanor related to job function (i.e. under the influence of prescription/illicit drugs or alcohol).
Unprofessional conduct can result in the risk of professional license/ membership being revoked.
4
Q
Informed consent
A
- Informing clients of significant information for treatment, legal issues, reporting, risks, fees, etc.
- Should be documented, but can make mandated report if unable to get it
- Client is informed so that they choose to participate in treatment freely and no undue influence
- Verbal informed consent: done at start of session
- Written informed consent: typically done before first session
5
Q
Consent and Minors
A
- Generally, parents must consent to treatment; some states have exceptions, such as California where minors can consent at age 12 and older if they meet medical necessity.
- Emancipated minors can generally consent themselves.
6
Q
Confidentiality
A
- Legally required to keep the content of therapy confidential
- There needs to be a written release or legal mandate (e.g. Subpoena) to breach confidentiality
- Code of ethics and standard practice requires verbally disclosing limits of confidentiality to clients as part of informed consent
- Verbal consent is acceptable in emergency situations.
- For couples & families, you need everyone’s signature and you may not release an individual’s confidence to others in the family unit without written permission (unless there is a written no-secrets policy).
7
Q
Record Keeping
A
- Must maintain client records for 7 years (7 yrs after minor’s 18th birthday in most states).
- You must provide reasonable access to records for clients.
- For couples or families, need written release from everybody.
- Clients generally have legal rights to copies of their records.
8
Q
Two types of Notes
(Record Keeping)
A
- Progress notes: typical “medical record; released to client
- Psychotherapy notes: Therapist’s personal notes that are not part of the medical record and are kept separate and may be subpoenaed in certain circumstances (such as therapist defending self in lawsuit)
9
Q
Privilege
A
- Maintaining client’s confidentiality in legal settings (e.g., court case). Typically, client is the holder of the privilege, even when a minor.
- Therapist may “claim client privilege” when asked to disclose confidential information in a legal proceeding.
- Only the client can waive their right to privilege. Even if client wants to waive, clinician must consider if it’s in client’s best interest.
10
Q
Subpoenas
A
Only release client’s records if:
- Client signs a release of information permitting you to respond
- Judge signs subpoena (not attorney)
When responding to subpoena:
- Assess subpoena for validity (judge signature)
- Contact your attorney
- Ask client what they want to do (possibly sign release to speak with their attorney)
- Claim privilege unless ordered by judge or client signs release
11
Q
Exceptions to Confidentiality/Privilege
A
- Child/Elder Abuse reporting
- Threat of harm to self/other mental or emotional condition is part of a lawsuit.
- Client alleges Therapist misconduct and Therapist Must defend self legally.
- If therapy was court ordered or Client is defendant in criminal case and therapy used to determine sanity.
12
Q
Dual/Multiple Relationships
A
Having two relationships with a client (clinical + another role). Not all are problematic, but should be avoided whenever possible. More common in rural areas and small communities.
In particular, therapists must avoid relationships with Power Differentials such as:
- Sexual relationships with clients (often a crime)
- Personal relationship with clients
- Personal relationship with students/supervisees
- Sexual relationship with students/supervisees
13
Q
Client Autonomy
A
The client’s right and responsibility to make decisions regarding relationships such as cohabitation, marriage, divorce, separation, reconciliation, custody, and visitation.
14
Q
When Therapy Benefiting the Client
A
Once therapy no longer benefits the client then therapy services must end.
15
Q
Non-Abandonment & Referral
A
Cannot abandon clients; you must make reasonable arrangements for continuation of treatment if unable or unwilling to provide treatment. In general, therapists should get supervision if referral is due to therapist issue; but may need to refer for serious conflicts of interest.
16
Q
Gifts
A
- Consider the potential effects on the therapeutic relationship.
- Attend to cultural norms when deciding to accept or give gifts.
17
Q
Supervision
A
Not allowed to provide therapy to current supervisee or student. Do not disclose what a supervisee says except by written authorization or where permitted by law. In educational and training settings, disclosures are permitted to others who share responsibility.
18
Q
Telehealth
A
- Must first be trained to provide telehealth services
- Must determine if telehealth services are appropriate given the Client/ supervisee professional, as well as intellectual, emotional, and physical needs.
- Must have explicit consent including the risks of telehealth.
- Therapist Must ensure technology is secure based on best practices & laws
- Therapist Must be licensed in the state where the Client is physically located
19
Q
Financial Arrangements
A
- Must disclose all fees at the start of therapy, how fees are collected
- Must give reasonable notice to clients if use of collection agency or legal recourse
20
Q
Insurance Fraud
A
- Routinely waiving copayments
- Assigning inaccurate diagnosis
- Bill for missed appointments without making it clear session was missed
- Filing claim for individual when saw couple/family
- Billing both insurances for couple session
- Having someone else sign claim as provider of services
21
Q
Advertising
A
- Must be accurate and include educational credentials (Must be related to MFT)
- Can include specializations only after reasonable steps to ensure competence
- Correct whenever possible inaccurate information
22
Q
Unethical Behavior of Colleague
A
- Not clearly addressed in the Code of Ethics
- Generally discuss with colleague first
23
Q
HIPAA Privacy Rule
A
- Law that regulates the use and disclosure of patients’ protected health information (PHI).
- Can decline HIPAA release of records if you believe it would do harm to client.
- Must get client’s written permission to use unsecure email
- Allows medical practitioners to exchange information WITHOUT CLIENT CONSENT if necessary to diagnose, prescribe, or treat, especially in emergency situations (important for client safety)
- Clients must sign HIPAA Notice of Privacy Policy
24
Q
Child Abuse Reporting
A
- Must report when there is “Reasonable Suspicion” of sexual abuse, physical abuse, or neglect. Emotional abuse must be severe (e.g., locking in a closet) to be reportable.
- Therapists do not have an obligation to “investigate,” only to report suspected abuse
- Be aware of common physical/behavioral indicators of Abuse
25
Elder Abuse
* Physical (includes over/under medicating)
* Sexual
* Financial
* Abduction
* Isolation
* Abandonment
* Neglect (including self-neglect)
26
Suicidal Threats
* Assess for level of threat: Ideation, plan, means, intent, past experience, and protective factors
* Contact the client's family/psychiatrist
* Intervention includes hospitalization (if imminent threat) or intensive outpatient (only if lower risk of harm)
27
Threat to Harm to Others
| (Tarasoff)
"**Duty to Protect**"- when therapist believes there is an "imminent" threat (a plan, the means, and the intent) to another person/identifiable victim. Therapist must notify "reasonably identifiable victim" and police/authorities as soon as possible.
28
Domestic Violence/ Intimate Partner Violence
* **Do NOT breach confidentiality** to protect adult victim (unless risk of dependent adult, Child, or Elder Abuse)
* If a Child is affected then need to **report Child Abuse** related to the IPV
* In **treatment**: refer to medical care if necessary, create a safety plan, provide resources, including legal referrals, respect Client autonomy, treat trauma (increase coping), psychoeducation on Abuse/cycles of violence
29
Forensic Evaluation
* If you provide therapy to the Client then you cannot conduct a forensic interview (ex. custody evaluation)
* Must avoid conflicts with other clients, attorneys, etc.
* Must only provide professional opinions about people you personally interviewed
30
Exceptions to Confidentiality - 5 Categories
1. Suspected child abuse
2. Suspected elder or dependent adult abuse
3. Danger to self or others
4. Legal authorization (court order, client release)
5. Other less common instances where disclosure is required or permitted
31
Sexual Relationships with Clients
* Considered **abuse of power**.
* Prohibited under state law and all **codes of ethics.**
* Generally prohibited for **2 years after last professional contact**.
* AAMFT code of ethics prohibits **forever**.
* **NOT** covered by liability insurance.
32
No Secrets Policy
Couples/family therapy policy where **therapist will not keep secrets between family members** - anything disclosed individually may be shared with other family members if clinically relevant.
33
Limited Secrets Policy
Couples/family therapy policy allowing **some individual confidentiality** with limitations that must be clearly defined and agreed upon at start of treatment (e.g. violence within the family).
34
Reasonable Suspicion
The standard for mandated reporting - therapists need reasonable suspicion of abuse, **NOT proof** or investigation. Based on professional judgment.
35
Imminent Danger
Clear and **immediate** threat required for Tarasoff duty to protect. Must involve **severe bodily harm** to reasonably identifiable victim.
36
Active vs. Passive Suicidal Ideation
**Active**: wants to kill themselves with plan, means, and intent.
**Passive**: wishes they weren't here but no active plan to die.
Active ideation with imminent threat requires immediate intervention.
37
Psychotherapy vs. Forensic Evaluation
Psychotherapists are biased witnesses **who cannot give forensic evidence** in court for a person they are treating.
Only unbiased third-party court evaluators can provide forensic opinions.
Never write letters for court for an ongoing psychotherapy client. Must be assigned to be the forensic evaluator.
38
Self-Disclosure
* Sharing **personal** information with clients.
* Must weigh **risks vs. benefits** carefully.
* **Err on the side of caution** as potential harm cannot be undone.
* **Values disclosure** is most sensitive.
39
Bartering
Bartering **strongly discouraged** except where customary and not exploitive.
40
Access to Records
* Clients generally have **legal right to access their records** and those of minor children.
* Therapist may withhold if believes harmful.
* Can offer clients a summary instead but cannot give in lieu of full record if client insists on accessing full record.
41
Professional Boundaries
Clear therapeutic boundaries are ethical imperative. Generally defined as **no other relationships besides therapeutic relationship**. Clinician's job to enforce even if client wants friendlier relationship.
42
Death with Dignity
In states/countries allowing medically assisted suicide for terminally ill, professionals may NOT breach confidentiality if client chooses this legal option.
43
Communication Outside Session
* **Email** must be on HIPAA-compliant platform or get release.
**Texting** rarely HIPAA-compliant - **MUST have signed release**.
* **Social media**: should have written policy, don't follow clients, don't allow them on personal accounts.
44
Consensual Sex: Under 14 Years Old
If one sexual partner is 14 years or older and the other is under 14, the therapist **must report as child abuse**.
45
Consensual Sex: Ages 14-17
**21/16 or 'Drinking and Driving' Rule (CA)**
If one sexual partner is old enough to drink (21), the other partner must be old enough to drive (16), or therapist must report as child abuse.
46
Ewing v. Goldstein (2004)
California case establishing that **warnings from family** about client being potentially violent should be treated similarly to threats from the client themselves for Tarasoff purposes.
47
Therapy Never Includes Sexual Behavior
Californai requires giving clients **specific brochures about prohibition of sexual relationships between clients and therapists.** Required intervention when learning about sex between client and another therapist.
California MFT
flashcards
Decks in class (21)
# Cards
-
DSM-5-TR Diagnosis104
-
Mental Status and Clinical Assessment52
-
Law, Ethics, and Crisis47
-
General Treatment, Tx Planning, and Termination32
-
Systemic and Cybernetic Foundations38
-
Strategic and Systemic Theories35
-
Structural Family Therapy35
-
Intergenerational/Bowen Therapy31
-
Experiential-Satir Family Therapy22
-
Emotionally Focused Couple and Family Therapy22
-
CBT/CBFT41
-
Rational Emotive Behavioral Therapy25
-
Dialetic Behavior Therapy (DBT)19
-
Psychodynamic Family Therapy22
-
Attachment-Based Psychotherapy (Psychodynamic)28
-
Object Relations Therapy26
-
Self Psychology20
-
Postmodern: Narrative & Solution-Focused41
-
Person-Centered Therapy (Carl Rogers)21
-
Gestalt Therapy (Fritz Perls)19
-
Family Development Theories35
