Chapter 5 - Clients rights and counselor responsibilities PDF

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Chapter 5 Client rights and counselor responsibilities Informed consent     

Involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it Both an ethical and a legal obligation of the clinician Not only meets legal and ethical standards but represents excellent clinical care as well Requires that the client understands the information presented, gives consent voluntarily, and is competent to give consent to treatment A process that continues for the duration of the professional relationship

Content of informed consent 

The following information should be provided in writing and discussed o The therapeutic process (including assessment) o Background of therapist o Costs involved in therapy o The length of therapy and termination o Consultation with colleagues o Interruptions in therapy o Benefits and risks of treatment o Using telecommunication technology o Alternatives to traditional therapy o Tape-recording or videotaping sessions o Client’s right of access to their files o Rights pertaining to diagnostic classifying o The nature and purpose of confidentiality

Record-Keeping 

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From a clinical perspective: o Record-keeping provides a history that a therapist can use in reviewing that course of treatment From an ethical perspective o Records can assist practitioners in providing quality care to their clients From a legal perspective o State or federal law may require keeping a record o Many practitioners believe that accurate and detailed clinical records can provide and excellent defense against malpractice claims From a risk management perspective o Keeping adequate records is the standard of care

Content for Inclusion in records            

Client-identifying data Client’s chief complaints Physical exam objective findings Intake sheet Documentation of referrals and informed consent Findings from consultations, referrals, diagnostic procedures, and tests Diagnosis and Prognosis Treatment Plan Signed and dated progress notes Appointment dates, times, and types of services Termination and discharge summary Release of information

Securing records 

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Counselors have the responsibility for storing client records in a secure place and exercising care when sending records to others by mail or through electronic means Helping professionals who utilize the “cloud” as an offsite storage tool may be exposing themselves and their clients to unforeseen risks

Ethical issues in online counseling  

It is the counselor’s responsibility to examine the ethical, legal, and clinical issues related to online counseling Basic issues such as self-disclosure, confidentiality, boundaries, and dual relationships can take on unexpected shapes in online counseling

Mistakes of omission in online counseling        

Obtain informed consent prior to services Limit access to personal information Obtain a clinical license to practice in the state in which the client resides Comply with HIPAA confidentiality requirements Respond in a timely manner Terminating online services to clients abruptly Claiming expertise in providing online services outside the scope of one’s education and training Providing online services to clients who clinical needs are so severe that they require in-person services

Some advantages of online counseling

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Reaching clients who are reluctant to participate in face-to-face therapy as well as those who have certain disabilities or chronic illnesses that render them immobile Improving client access in rural areas The potential for greater numbers of people to receive services

Some disadvantages to online counseling     

Danger of making an inaccurate diagnosis Compromising confidentiality and privacy Difficulty in protecting clients in crisis Challenges of working through transference and countertransference Lack of competence and danger of the misrepresentation of a counselor’s qualifications

Legal issues and regulation of online counseling    

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A clinician’s license is intended for practice in the state where he or she is licensed to practice Counselors need to stay current regarding the changing laws pertaining to counseling across states Malpractice insurance carrier may not plan to cover out-of-state counseling Licensing boards have a legal mandate to protect consumers who live in their state; they do not have an obligation to consumers who do not reside in their state If a California consumer is traveling to another state and wants to participate in counseling via telephone (or online) the California-licensed therapists must receive permission from the temporary location

Working with children and adolescents 

Important issues to consider o Minor’s rights regarding informed consent o Parental rights to information about a minor’s treatment o Minor’s assent versus consent o Involving parents in the counseling process with minors o Limits to confidentiality o Dealing with reluctance o Need for supervised clinical experience in play therapy, art and music therapy, and recreational therapy

Unethical behavior of colleagues

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Ignoring evidence of peer misconduct is an ethical violation in itself o Many helping professionals are reluctant to address such problems Informed peer monitoring provides an opportunity for corrective interventions to ethically questionable acts If informal measures are not enough, reporting a colleague to a professional board is one of several options open to you

Malpractice Liability 

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Malpractice means “bad practice” o The failure to render professional services or to exercise the degree of skill that is ordinarily expected of other professionals in a similar situation Professional negligence can result from unjustified departure from usual practice or from failing to exercise proper care in fulfilling one’s responsibilities Standard of care: Standards that are commonly accepted by the profession and are considered as the acceptable standard of practice in the community

Elements of Malpractice 

To succeed in a malpractice claim, four elements must be present: 1. A professional relationship between the therapist and the client must have existed 2. The therapist must have acted in a negligent or improper manner, or have deviated from the “standard care” by not providing services that are considered “standard practice in the community” 3. The client must have suffered harm or injury, which must be verified 4. There must be a legally demonstrated causal relationship between the practitioner’s negligence or breach of duty and the damage or injury claimed by the client

Reasons for malpractice suits          

Failure to obtain or document informed consent Refusal to counsel clients due to value differences Client abandonment or premature termination Marked departures from established therapeutic practices Sexual misconduct with a client Practicing beyond the scope of competency Negligent assessment or misdiagnosis Repressed or false memory Unhealthy transference relationships Failure to assess and manage a dangerous client

Risk management

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The practice of focusing on the identification, evaluation, and treatment of problems that may injure clients and lead to filing an ethics complaint or a malpractice action One of the best precautions against malpractice is personal and professional honesty and openness with clients Know your limitations and seek consultations in difficult cases Remain alert for possible misunderstanding that, if not recognized or poorly handled, could lead to a therapeutic break or premature termination of therapy

Course of action in a malpractice suit        

Treat the lawsuit seriously Do not attempt to resolve the matter with the client directly Contact the ethics and risk management services of your professional associations Become familiar with your liability policy, including limits of coverage, and contact insurance company immediately Never destroy or alter files or reports pertinent to the client’s case Do not discuss the case with anyone other than your attorney Determine support available to you from professional associations Do not continue a professional relationship with a client who is bringing a suit against you...