OUTLINE

A. ETHICALLY IMPORTANT DEFINITIONS and DISTINCTIONS

Privacy vs. Confidentiality vs. Privilege
Voluntary vs. “Involuntary” Disclosures
Required Disclosures vs. Allowed Disclosures
            1. Ethically Required Disclosures 
            2. Ethically Allowed Disclosures
            3. Legally Required Disclosures
            4. Legally Allowed Disclosures

B.  WHAT DID BOLLAS CLAIM IN 1995?

C.  WHAT ARE THE REALITIES NOW?

D.  THE COMPLICATED ETHICS OF “CONDITIONAL” CONFIDENTIALITY

E.  COULD YOU REDUCE VOLUNTARY/INVOLUNTARY DISCLOSURES:
            In Your Own Practice?
            In Your Group or Organization?
            Among Your Colleagues ?
            Within Your Profession’s  Stance or Guidelines?  

Educational Goals:
1. List some examples of circumstances in which you have disclosed without consent voluntarily.
2. List some examples of circumstances in which you have disclosed information “involuntarily.”
3. Describe the potential impact on patients or on you in those situations.
4. State how you might now handle a previous confidentiality situation differently.

1.  Personal Moral Code vs. Professional Ethics

2. Ethically-Required vs. Ethically-Permitted Behavior

3. Ethically-Required vs. Legally-Required Behavior

4. Ethically-Prohibited vs. Legally-Prohibited Behavior

5. Legally-Required vs. Legally-Permitted Behavior

6. Voluntary Disclosures vs. “Involuntary” Disclosures

7. Ethical Focus vs.  Legal Focus vs. Risk Management

 8. Privacy vs. Confidentiality vs. Privilege

 9. Boundaries vs. Dual Relationships

10. Psychotherapy vs. Counseling vs. Coaching vs. Friendly Advice

1 1. …………………………………………………………………………    

 Educational Goals:
1. Give examples of some important ethical and ethical-legal distinctions.
2. Describe why it would be ethically important for you to be able to make those distinctions.
3. Describe the potential impact on patients or to you if you are unclear about each of those.

INTRODUCTION: 
“Competent” With How Many “Cultures”  ? 

  I.  Ethics Codes & Professional Guidelines

 II. Definitions

Competence
Culture
Ethnicity
Diversity & Multiculturalism
Inclusion
Race 

 III.  “Cultural” Variables

Age
Gender
Geographical  Origin or Location
Immigration Status
Language
Political Preference
Race/Ethnicity
Religion/Morality
Sexual  Orientation
Socioeconomic Variables

 IV. Impediments to “Multicultural Competence”

Educational Goals:
(a) To understand my profession’s definitions of “culture” and “competence.”
(b) To identify the different “cultures” with which  I am already competent.
(c) To consider other “cultures” with which I would like to become more competent.
(d) To decide how  I can gain and maintain that multicultural competence.

 (Who Said Ethics Was Boring?)

 The first half of this workshop is an overview of  
some simple, basic topics in professional ethics and Virginia law.
The second half of the workshop will be conducted a bit like a “Jeopardy” game.
Using the categories below, we will test our understanding of 
what we have learned about the ethical/legal ABCs.
An unusual variation on the boring “post-test”!!  

  Categories: “Ethical & Legal ABCs”  

Dilemma 1: Therapist in the Middle

Dilemma 2: A Suffering Caregiver

Dilemma 3: A New Referral?

Dilemma 4: A Therapist in Turmoil

Dilemma 5: A Tricky Situation

Dilemma 6: Referral and Treatment Boundaries

Dilemma 7: An Invitation to Assess

Dilemma 8: A Session with the Spouse

Dilemma 9: Therapist as Character Witness

Dilemma 10: Multiple Relationships Revealed

Dilemma 11: An Unexpected Inheritance

Dilemma 12: A Request for Assistance

Dilemma 13: Troubles in the ICU

Dilemma 14: The Psychology of Advertising

Dilemma 15: To Evaluate or Not to Evaluate

Dilemma 16: Money Matters

Dilemma 17: Titles, Roles and Boundaries

Dilemma 18: Co-authorship with a Former Patient

Dilemma 19: A Missing Patient

Dilemma 20: Has the Therapist Done Too Much?

Dilemma 21: A Phone Call From a Friend

Dilemma 22: A Duty to Report?

Learning Objectives:
1. To use provided clinical vignettes to practice how to recognize the ethical and legal issues.
2. To use suggested categories to consider options for ethical response to the dilemma.
3. To provide hypothetical vignettes based on ethical/legal dilemmas in my own practice.

This workshop is designed to review and organize the broad range of
ethical and legal information that mental health professionals are responsible for knowing.
Categories must encompass ethical topics such as those below
& must also reflect legal sources of information about those topics from
state and federal sources such as those below.

EDUCATIONAL GOALS:
1. To consider categories that would help me organize essential ethical and legal material.
2. To test the usefulness of those categories using hypothetical cases from my own practice.
3. To practice using those categories with case vignettes that involve ethical and legal issues.

Dilemma 1: Therapist in the Middle

Dilemma 2: A Suffering Caregiver

Dilemma 3: A New Referral?

Dilemma 4: A Therapist in Turmoil

Dilemma 5: A Tricky Situation

Dilemma 6: Referral and Treatment Boundaries

Dilemma 7: An Invitation to Assess

Dilemma 8: A Session with the Spouse

Dilemma 9: Therapist as Character Witness

Dilemma 10: Multiple Relationships Revealed

Dilemma 11: An Unexpected Inheritance

Dilemma 12: A Request for Assistance

Dilemma 13: Troubles in the ICU

Dilemma 14: The Psychology of Advertising

Dilemma 15: To Evaluate or Not to Evaluate

Dilemma 16: Money Matters

Dilemma 17: Titles, Roles and Boundaries

Dilemma 18: Co-authorship with a Former Patient

Dilemma 19: A Missing Patient

Dilemma 20: Has the Therapist Done Too Much?

Dilemma 21: A Phone Call From a Friend

Dilemma 22: A Duty to Report?

Learning Objectives:
1. To use provided clinical vignettes to practice how to recognize the ethical and legal issues.
2. To use suggested categories to consider options for ethical response to the dilemma.
3. To provide hypothetical vignettes based on ethical/legal dilemmas in my own practice.

What Do You Wish You Had Known About …….

The ethics of beginning a therapy relationship

The ethics of ending a therapy relationship

What to to tell minors about confidentiality

What to tell couples about confidentiality 

How to start a practice and run a business

The difference between “legally-required” and “legally-allowed”

What to do first if you receive a subpoena

Whether or not to keep “psychotherapy notes” 

What legal options are available if a patient threatens to harm someone

Whether you have any legal obligations if a patient threatens suicide

How to turn down a gift from a patient

The importance of having confidentiality contracts with your staff

………………………………

Educational Goals:

1. List some examples of clinical circumstances in which you were not well prepared.

2. Describe the potential impact on patients or risks to you in those situations.

3. State what you now know that would lead you to handle the situation differently. 

OUTLINE

A. ETHICALLY IMPORTANT DEFINITIONS and DISTINCTIONS

Privacy vs. Confidentiality vs. Privilege
Voluntary vs. “Involuntary” Disclosures
Required Disclosures vs. Allowed Disclosures
            1. Ethically Required Disclosures (None)
            2. Ethically Allowed Disclosures
            3. Legally Required Disclosures
            4. Legally Allowed Disclosures

B.  WHAT DID BOLLAS CLAIM IN 1995?

C.  WHAT ARE THE REALITIES NOW?

D.  THE COMPLICATED ETHICS OF “CONDITIONAL” CONFIDENTIALITY

E.  COULD YOU REDUCE VOLUNTARY/INVOLUNTARY DISCLOSURES:
            In Your Own Practice?
            In Your Group or Organization?
            Among Your Colleagues ?
            Within Your Profession’s  Stance or Guidelines?  

Educational Goals:
1. List some examples of circumstances in which you have disclosed without consent voluntarily.
2. List some examples of circumstances in which you have disclosed information “involuntarily.”
3. Describe the potential impact on patients or on you in those situations.
4. State how you might now handle a previous confidentiality situation differently.

I. Establishing Clear Policies

A. Administrative, Scheduling, & Financial Policies

B. Clinical Policies (e.g., Session Frequency, Time, & Timing)

C. Boundaries

Within the Session (Physical Boundaries; Therapist Self-Disclosure, etc.)

Outside the Session (In Person or Electronically)

D. Confidentiality & Disclosure

E. Informed Consent

II. Living Up to Our Informed Consent Promises

III. Avoiding the Predictable Pitfalls 

A. Resisting Temptations to Breach Confidentiality Unethically

Voluntary Disclosures

“Involuntary” Disclosures

B. Avoiding the Creation of “Avoidable” Conflicts of Interest

C. Resisting Pulls Toward Problematic Dual Relationships

D. Remaining Alert to Avoid Real or Perceived Boundary Violations

 IV. Monitoring Our Current State

A. Personal Stressors Leading to Therapist Over-Disclosure

B. Unmet Need for Support

C. Inadequate Self-Care Leading to Tired/Sleepy/Burned-Out

D. Unmet Need for Therapy 

V. Acknowledging Our Clinical Limitations

VI. Acknowledging Our Personal Vulnerabilities

VII.  Understanding the Consequences for Patients

EDUCATIONAL GOALS:
(1) Name some areas of clinical practice where it is easy to step onto an ethical “slippery slope.”
(2) Describe some of the potential consequences to patients.
(3) List the supports or reminders that would be helpful to you in avoiding these pitfall.