CA MFT Exam - Law & Ethics

MFT Scope of Practice

A legal term. An LMFT may:

Practice psychotherapy

Diagnose and treat mental disorders (in order to improve client's relationships)

Administer and interpret psychological tests (as long as doing so is within the MFT's scope of competence as determined by education, training, or experience, and as long as it is directed toward improving client's relationships

Privilege

A legal term. The legal right not to have confidential information revealed during legal proceedings or in court. The client or client representative holds the privilege.

Subpoenas and privilege

A therapist's first response upon receiving a subpoena is to assert privilege. The therapist can release records if the client gives him written permission to do so, or if the court orders him to do so.

Who holds privilege?

The client, if he is an adult, or if he is a minor who is receiving treatment without parental consent.

The court can waive the privilege

If a minor is a ward of the state, the minor holds privilege, which can be waived by the court or by the client's attorney

If there is a legal guardian, he/she can waive privilege on behalf of client

Exceptions to privilege

A judge decides if the facts of the case fall under one of the following exceptions to privilege:

The client has introduced his emotional condition in a legal proceeding

The client has treated information as if it were not confidential

The thx has been appointed by the court to examine the client

The thx has been ordered by the court to divulge information

The client has sought therapy to commit and/or escape punishment for a crime

Proceedings to determine sanity

Proceedings to establish client competence

Confidentiality

Both legal & ethical term

Thx cannot divulge HIV even if client is endangering a partner

Mandated reporters are allowed to respond to follow-up inquiries from investigators

Mandated Exceptions to Confidentiality

Suspected abuse

Tarasoff

The Patriot Act of 2002

Permissive Exceptions to Confidentiality

Client is a danger to self, or to the person or property of others (California evidence code 1024)

Disclosures to licensed professionals (such as supervisor or colleague) to get help in treating client

When there is an authorization to release PHI

When client has signed a health insurance claim form

Breach of duty (thx sues client for non-payment, or client sues thx for malpractice)

Child Abuse Reporting

Immediately by phone

Within 36 hours by written report

Optional reporting of child abuse

Emotional abuse and fetal abuse

Out of state reporting of child abuse

Must be reported no matter where it occurs, and no matter the location of the victim/abuser

All reports must always be made to CPS or law enforcement within California

Historical reporting of child abuse

When victim is now over 18, no report

When victim is now over 18, but thx has a reasonable suspicion that the perpetrator has or is abusing others who are currently under the age of 18

"Having access" is a myth; emphasis is on "reasonable suspicion"

Non-reportable "Lewd & Lascivious Conduct"

• A minor is under 14 years old and his or her partner is under 14 years old, assuming they are of "similar age, maturity, & sophistication."

• A minor is 14 years old and his or her partner is under 24 years old.

• A minor is 15 years old and his or her partner is under 25 years old.

Reportable "Lewd & Lascivious conduct"

If child is under 14 and is the recipient of "lewd & lascivious conduct" (touching in order to sexually arouse) by someone 14 or older, this is reportable

If child is 14 or 15 and is the recipient of "lewd & lascivious conduct" (touching in order to sexually arouse) by someone at least 10 years older (24 or 25), this is reportable

Reportable Sexual Intercourse

If child is under 14 and having sex with someone 14 or older, this is reportable

Under 16 & having sex with someone 21 or older, this is reportable

Non-reportable Sexual Intercourse

A minor is under 14 years old and his or her partner is under 14 years old, assuming they are of "similar age, maturity, & sophistication."

A minor is 14 or 15 years old and his or her partner is over 14 years old but under 21 years old

A minor is 16 years old or older and his or her partner is 14 or older

Forms of Elder Abuse

Physical abuse

Abandonment

Isolation (such as to keep them from reporting)

Neglect

Abduction

Financial

Tarasoff

Thx must protect an intended victim when client, close family member of client, or a credible 3rd party has told thx of client's "serious threat" (which mist be imminent) of "physical violence" to a "reasonably identifiable victim"

Tarasoff duty to protect

A thx has fulfilled his responsibility and saved himself from a lawsuit if he warns the police and the intended victim

Or, he can have the client hospitalized through a 5150 (but this does not provide immunity)

Thx should:

Tell police within 24 hours

Warn intended victim

Warn someone who can tell the intended victim

Have client dispose of the means

Institute a "no violence" plan

Have the client hospitalized

Whatever else can be done to protect the intended victim

Tarasoff related court decisions

Bellah vs Greenson: Tarasoff does not apply to threats of suicide or threats to property

Thompson vs Alameda: for Tarasoff to apply, the victim must be identifiable and the peril must be foreseeable

Headlined vs Superior Court of Orange County: Tarasoff damages can include bystanders (only adds to liability)

Melendez vs superior court: thx can use statements made by client in order to convince the victim of danger

Ewing vs Goldstein: the information need not come from client, but can come from family member or credible 3rd party

The Patriot Act of 2002

Allows the FBI or other government agents to get special subpoenas to compel therapists to turn over whatever PHI is wanted

AND, thx cannot disclose to client or anyone else that the records were sought or obtained

Suicidal Clients

Therapists must take "reasonable steps" to prevent suicide

These include:

A self-care plan

Increased contact (more sessions, more often)

Disposal of means

Referrals for medication

Telling friends/family so as to create a 24-hour no-suicide watch team

Voluntary hospitalization

Involuntary hospitalization

A thx may break confidentiality (Evidence code 1024), but should be able to demonstrate that it was necessary to do so

5150

Involves any client who is gravely disabled or a danger to self or others

Anyone can initiate a 5150, but only certain people can invoke a 5150

Who can invoke a 5150?

Police officers

Members of the attending staff of a county certified facility

Other professionals designated by the county

Partner Abuse Reporting

We never report

Only doctors who treat wounds from the abuse can report

Who can give consent to treat a minor?

Either parent in an intact marriage

Either parent in a divorce in which there is joint legal custody (unless otherwise stipulated in divorce decree)

Only the parent named as sole legal custodian (if there is one)

A legal guardian

Caregiver raising the child in the absence or unavailability of the parents, and who sign a "Caregiver's Authorization Affidavit." Parents/legal guardians can always override the caregiver

A minor parent can consent, as long as the parent is mature enough to understand the nature of the therapeutic process

Adoptive parents

Either unmarried biological parent

Stepparents cannot without a Caregiver's Auth Affidavit

Foster parents cannot; client's attorney does this

Emancipated Minors

This is a minor with the legal right to consent to treatment

A thx can treat an emancipated minor without parental consent

How to become an emancipated minor

Be at least 14 and

Be or have been legally married or

Be currently enlisted in the military or

Be emancipated by a court

Thx should ask to see marriage certificate, enlistment papers, or court order

Suspected child abuse reporting still applies as long as client is below 18

When we can treat a minor

The minor is 12 or older

The therapy is out-patient

The minor must be mature enough to participate intelligently in treatment

The minor is responsible for the therapist's fee (the parent is not responsible)

There is a good reason why involvement of parents would not be appropriate

Thx must enter into his case notes of his attempts to contact parents, or the reason for not doing so

There is no longer a requirement that the child be a danger to self or others, or a victim of incest

However, the minor cannot on his own consent to meds, psychosurgery, or electric shock therapy

When dealing with CSW's or probation officers

It's up to the thx to determine whether the information requested is "reasonably necessary" -- not the CSW or probation officer

Record Keeping

Must do so "consistent with sound clinical judgment, the standards of the profession, and the nature of the services being rendered"

Records must be stored, transmitted, transported, and disposed of in ways that protect client confidentiality

LMFT's urged to keep records for 10 years (psychologists required to keep them for 7)

In the case of a minor, keep records for 10 years or until minor is 21

Access to Records

Clients and parents can see records

Requests to see records must be in writing

Thx can then:

Let client see the actual records

Give client a copy of records

Give client a summary of records

Refuse access if substantial risk of detrimental consequences to client upon seeing the records

If thx refuses access, thx must determine that allowing access would harm therapeutic alliance or risk harm to client's physical or emotional well-being

Sexual misconduct with a client

Thx must give client the brochure entitled, "Professional Therapy Never Includes Sex"

If the reporting client is an adult, no report

If the client is a minor, report to CPS

If thx has reasonable suspicion that former thx may be abusing minors, must report

BBS will not receive a report of sexual misconduct from another thx

Sexual misconduct with a client-2

Prohibited by law and ethical standards

Is a felony

Thx is both civilly liable and criminally liable, even if client initiated or consented to it

Mandatory revocation of license

No sex with a client for 2 years

Grounds for divorce

"Blame" has been abolished

Irreconcilable differences on the part of at least 1 spouse

Incurable insanity

Must reside in California for at least 6 months

Must reside in the county for at least 3 months

Custody & Consent to treat a minor

Physical custody has no impact

Only legal custody matters

If there is "joint legal custody" or just "joint custody" then either parent

If there is sole legal custody, then it is whoever has that

Disability Insurance must cover

Schizophrenia, schizoaffective D/O, Bipolar D/O, Major Depressive D/O, Panic Disorder, Obsessive-Compulsive D/O, Autism Spectrum Disorder, Anorexia Nervosa, and Bulimia Nervosa

Telehealth

Written informed consent is not necessary, as long as thx documents consent in client's file

Supervision requirements-1

A licensed professional in private practice can supervise no more than 3 individuals registered MFT interns

Supervision requirements-2

A supervisor must have been licensed for at least 2 years

Must complete 6 hours of continuing education in supervision within 60 days of commencing supervision

Must complete 6 hours of supervision coursework in every licensing renewal period

Hypnotherapy & MFTs

No certification required

MFT must be competent through education, training, or experience

Psychological Tests & MFTs

We can administer and interpret such tests if we are competent (through education, training, or experience) and if they are given to improve client's relationships

Retired licenses

Cost is $40 for the rest of one's life

Cannot do anything that requires a license

Can restore license to active status by paying required fees and completing mandatory continuing education

Sexual Orientation

It is illegal for any mental health professional to engage in "sexual orientation change efforts" with anyone under the age of 18

Victims of violent crime

Minors who suffer emotional injuries as a result of witnessing a violent crime may be eligible for up to $5,000 for mental health counseling through the California Victim Compensation Program

Victims of Sexual Assault

May request a forensic medical exam without any obligation to participate in the criminal justice system. And the cost of the exam cannot be charged to the victim.

CAMFT Ethical Standards

MFTs should be familiar with these and use them as a guide for ethical behavior

CAMFT Ethical Behavior

Must satisfy the judgment of:

The individual therapist

His/her peers, based upon a set of recognized norms

Responsibility to patients-1

Must not condone or engage in discrimination on the basis of race, gender, gender identity, gender expression, religion, national origin, age, sexual orientation, disability, SES, or marital status. Must make reasonable efforts to accommodate clients with physical disabilities

Responsibility to patients-2

Must be aware of and not perpetuate historical and social prejudices when diagnosing and treating patients because such conduct may lead to misdiagnosing and pathologizing patients

Responsibility to patients-3

Must avoid dual relationships that are likely to impair professional judgment or exploit a client. Not all dual relationships are unethical. When one occurs, MFTs must take steps to ensure that judgment is not impaired and that no exploitation occurs.

Responsibility to patients-4

No borrowing money, hiring, engaging in a business venture or close personal relationship with a client or client family member

Responsibility to patients-5

No sex with clients or client family members

No therapy with someone with whom thx has had a prior sexual relationship with

No therapy with the partner/spouse of person with whom thx has had a prior sexual relationship with

Responsibility to patients-6

Must provide contact information and specified procedures in case of emergency or therapist absence

Responsibility to patients-7

Use sound clinical judgment when terminating and do so in an appropriate manner

Reasons for termination

Client not benefiting from therapy

Continuing treatment is not appropriate

Thx is unable to provide treatment due to the therapist's incapacity or extended absence

To avoid an ethical conflict or problem

Responsibility to patients-8

MFTs do not abandon or neglect clients in treatment. If I can't continue treatment, I must make arrangements for continuation of treatment

Responsibility to patients-9

MFTs do not maintain the therapeutic relationship solely for financial gain. We cannot terminate for non-payment of fees except when termination is handled in a clinically appropriate manner

Responsibility to patients-10

MFTs are client-centered, so we respect their choices, including those we may not morally agree with. In addition, we put together treatment plans in harmony with client choices and goals, and the offer a reasonable likelihood of client benefit.

Responsibility to patients-11

If we do therapy via Skype or telephone, we are careful to go over the potential pitfalls of this, such as any risks involved, issues of confidentiality, clinical limitations, transmission difficulties, and ability to respond to emergencies.

Responsibility to patients-12

Whenever the MFT's personal values, attitudes, and/or beliefs are a determinative factor in diagnosing or limiting treatment provided to a client, we must disclose such information to the client.

Responsibility to patients-13

We must inform clients of potential risks/benefits when utilizing novel or experimental techniques, or when there is a risk of physical harm from the utilization of any technique

Responsibility to patients-14

We must inform clients of the extent of our availability for emergencies and other contacts between sessions. If we are out of town, we must provide resources locally for client to contact in an emergency.

Responsibility to patients-15

MFTs do not withhold patient records or information solely because the therapist has not been paid for prior services

Responsibility to patients-16

MFTs do not limit their discussions of treatment options to what is covered by 3rd-party payers

Financial Arrangements

MFTs do not offer or accept payment for referrals

Disclose their fees and fee arrangements in advance

Advertising

MFTs do not solicit testimonials from clients

MFTs can represent themselves as specializing, as long as they have the education, training, or experience to back it up

At the first session:

MFT interns must provide name of employer, supervisor & type of license, intern registration number

When interns advertise:

Must include name of employer, the fact that the intern is under supervision, the intern registration number, and the title "marriage and family therapist registered intern" if the abbreviation MFTI is used in the advertisement