When I decided to embark on a master's degree in counseling, the idea of law and ethics being a part of the curriculum or my career did not exist. I did not consider how much legal and ethical issues are intertwined in the career of counseling. Of course I was aware of confidentiality and HIPAA, but there was so much more to learn about law and ethics in counseling. My graduate class in Law and Ethics was amazing! I began to see how important it is for me to know certain court cases and statutes. Recently, in my third day of training at my internship, my knowledge of law and ethics expanded, as I began to see how each state has certain codes that I need to know as well.
SHAAG MR SOCS is an acronym used to help remember the important legal and ethical concepts in counseling. So, what does it stand for?
- S - Self Harm and Suicide
- H - Harm to Others
- A - Abuse of Person
- A - Abuse of Substances
- G - Gravely Disabled
- M - Minors
- R - Releases
- S - Scope
- O - Office Policy
- C - Confidentiality
- S - Special Considerations
If you notice, the terms in blue are crisis issues, the terms in green are legal and ethical issues, and the terms in red are ethical issues.
Self Harm and Suicide
- Confidentiality - one of the ways confidentiality can be broken is through suicide
- Standard of Care - defined retroactively by a judge - think about would everyone (counselors) be doing the same thing? Be consistent with counseling services. Be aware of the SOC for your scope of practice.
- Documentation - document what you do and what you don't do. Document, Document, Document
- Assessment of Suicide Ideation - signs of depression, anxiety, impulsively, insomnia, substance abuse, hopelessness, aggression, anhedonia, ambivalence - Is there a pre-existing psychiatric diagnosis? Past suicide attempt? What are the precipitants? What is the timing? Consequences and medical severity? Are significant others involved? What is the client's assessment of past attempts? Is there past psychiatric treatment? Past relationship with therapist? Medical history? Family history? Strengths and vulnerabilities? Current stressors - are they acute or chronic? Use direct questions - Do you want to be dead or do you want your life to be better?
- Questions about the SI - Nature. Frequency. Timing. Extent: Specific Plan. Interpersonal relationships and situational context.
- Questions about the plan - Is there a plan? Conditional? Is there intent? Is there a means? Is there a time line?
- Assess degree of severity - motivation? seriousness? lethality?
- Protective factors - what keeps people alive? Children in the home. Responsibility to family. Pregnancy. Religious. Life Satisfaction. Reality testing. Coping Skills. Problem Solving. Social Support. Strong Therapeutic Relationship.
Harm To Others
- Duty to Warn and Protect: "Tarasoff" Client directly reports to the therapist a serious threat of physical violence against a reasonably identifiable victim.
- CA Civil Code Section 43.92
- Ewing I and Ewing II (Dr. Goldstein) - Court of Appeal, 2nd District - Communication from family is considered patient communication.
Abuse of Person
- Reasonable Suspicion
- CPS - Child Protective Services - remember time line to immediately call and write a written report within 36 hours California CPS
- APS - Adult Protective Services - goal is to keep family together because the family may be unaware what constitutes elder abuse (i.e., isolation; cultural differences) - remember time line to immediately call and 2 working days for written report - Elder Abuse: 18-64 years old with disability or 65 years and older. California APS
Abuse of Substances
- Assess...assess...assess...always!
Gravely Disabled
- Person who, as the result of mental disorder, is unable to provide his or her basic needs.
Minors
- Parental Consent
- Caregiver Consent
- Minor Consent
- Minors can seek treatment without parental consent if: they are at least 12 years old, victims of abuse, there is potential for harm if counseling is not offered, they are an emancipated minor that is established through the court - 14yrs old - military service - legally married
- Document attempt to get parental consent
Releases
- Always obtain release of confidential information when clients are receiving treatment from another mental health provider
Scope
- Practice
- Agency
- Competency - education, training, and supervision
Office Policy
- Fees
- Parking
- Cancellations
- Scheduling
- Informed Consent
- Availability
Confidentiality
- Ethical concept
- Be aware of the Patriot Act 2001 and Renewal 2006
Special Considerations
- Culture
- Countertransference
- Dual Relationships
- Sex with Clients
- Boundaries
- Self-Care
HIPPA
- Confidentiality - ethical
- Privilege - legal - no one can disclose confidential information without the client's expressed permission
Ethical Principles
- Fidelity - faithfulness - duty to relationship
- Autonomy - allowing the client to make their own decision
- Beneficence - do good - never harm client intentionally
- Ethical Obligations
- Provide safety
- Obtain informed consent
- Determine level of care
- Scope of practice
- Countertransference
Principle of Double Effect
- Bioethical principle
- Therapy can have good and bad effects
- Intent is for the good effect
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