Legal and Ethical Exam
Law and Ethics Study Guide : Final Exam
1. Circumstances Under Which a Therapist MUST or MAY Break Confidence
● MUST Break Confidence:
○ Child Abuse: Physical abuse, sexual abuse, neglect, willful cruelty, or unjustifiable punishment.
○ Elder and Dependent Adult Abuse: Physical abuse, neglect, financial abuse (for elders), and other forms of mistreatment.
○ Duty to Protect (Tarasoff): When a client communicates a credible threat to a specific, identifiable victim. Therapists must inform law enforcement within 24 hours and take steps to protect the intended victim.
○ Client-Authorized Release: If the client signs a release allowing disclosure.
● MAY Break Confidence (Permitted but Not Required):
○ Severe Emotional Abuse of a Child: Considered for a possible report if there’s evidence of severe emotional damage.
○ Suicidality: Permitted under Evidence Code 1024 if breaking confidentiality is necessary to prevent harm.
2. Privilege vs. Confidentiality and Exceptions to Privilege
● Privilege:
○ A legal concept limiting access to therapy records in legal proceedings.
○ The client holds the privilege (or their legal guardian if a minor).
● Exceptions to Privilege:
○ Evidence Code 1016: Privilege is waived when a client’s mental health is part of a legal claim.
○ Evidence Code 1024: Privilege is not upheld if disclosure is necessary to prevent harm to self, others, or property.
● Confidentiality:
○ A broader concept prohibiting sharing of therapy information, except as allowed or required by law.
3. Types of Child, Elder, and Dependent Adult Abuse
● Child Abuse: Physical abuse, sexual abuse, neglect, willful cruelty, unjustifiable punishment, and unlawful corporal punishment.
○ Not every spanking qualifies unless it causes physical damage. (Kathy won’t test on specifics of unlawful corporal punishment.)
● Elder and Dependent Adult Abuse: Physical abuse, neglect, financial abuse (elders), and abandonment.
○ Dependent Adult: Defined by inability to manage daily living or needing care due to disability or temporary condition. (Kathy won’t test on precise definitions.)
● Legal Mandates:
○ Therapists must report abuse to appropriate authorities (e.g., CPS, APS).
4. Duty to Protect (Tarasoff Situations)
● Definition: Therapists must act if a client communicates a threat to an identifiable victim.
● Mandates:
○ Inform law enforcement within 24 hours.
○ Take reasonable steps to protect the victim, which may include notifying them.
○ If warning the victim increases danger (e.g., gang violence), therapists can opt for alternative protective actions.
5. Suicidal Clients: Legal and Ethical Considerations
● Therapists are permitted to break confidentiality under Evidence Code 1024 if necessary to prevent harm.
● Therapists must assess risk and may involve hospitalization, contacting family, or other interventions.
6. Patient Access to Psychotherapy Records
● Adult Patients: Have the right to access their records unless access would harm their mental health.
● Minors: Parents/guardians generally have access, but minor confidentiality is protected in specific contexts (e.g., when the minor is legally seeking therapy without parental consent).
7. Minor Emancipation in California
● A minor becomes emancipated through:
○ Marriage.
○ Active military service.
○ A court order following proof of financial independence.
8. Therapy for Minors Without Parental Knowledge/Consent
● Minors aged 12 or older may consent to therapy without parental knowledge under California law if:
○ They are mature enough to participate in therapy.
○ The therapy is for their well-being.
● Age Requirement
○ Must be at least 12 years old
○ Different from the age 14 for emancipation
● Maturity Requirement
○ Must be mature enough to participate intelligently
■ Ability to understand what therapy involves
■ Maturity is often a judgment call by the therapist
● Financial Consideration
○ Typically, therapy for minors at this age occurs in settings where there is no charge (e.g., school, agency)
○ Parents cannot be billed or asked to pay if they did not consent to the therapy
● Justification for Non-Disclosure
○ Must demonstrate that informing the parents would be detrimental to therapy
■ Documentation is necessary
■ General term: Inappropriate to contact parents or guardians
■ E.g., the minor does not want parents involved
● Previous Legal Standards
○ Historically, more restrictive under Family Code 6924
■ Required the minor to be a victim of abuse or in obvious danger
● Current Interpretation of "Good Reason"
○ Modern interpretation is more flexible
■ Often sufficient for non-disclosure is simply that the child does not want it
● Potential for Later Involvement of Parents
○ Therapists might later choose to involve parents if there are issues of child abuse or danger
○ Important to discuss with the minor that parental involvement may be necessary, as part of informed consent
● Bottom Line
○ Consent to treat can come from the minor who is at least 12 years old, deemed mature, and with a good reason established for not involving parents.
Notes on Test Content
● Kathy explicitly stated not to worry about the specifics of unlawful corporal punishment or detailed definitions of dependent adults on the test.
9. Grounds for Dissolution of Marriage, Spousal Support, and Child Custody
● Grounds for Dissolution of Marriage in California:
○ The primary ground is irreconcilable differences.
○ A second, rarely used ground is incurable insanity. (The Kathy noted this won’t be tested.)
● Spousal Support Determination:
○ Based on the need of one person to be supported and the ability of the other person to pay.
○ California is a no-fault divorce state, so the behavior of either spouse (e.g., infidelity) does not influence spousal support.
○ Spousal support typically ends when the supported spouse no longer needs it or remarries.
● Child Custody Guidelines:
○ Custody arrangements consider the best interest of the child, which is subjective and varies by case.
○ Common custody types:
■ Legal Custody: Determines decision-making power over the child’s education, healthcare, and upbringing.
■ Joint Legal Custody (common): Both parents share decision-making power.
■ Sole Legal Custody (rare): One parent has full decision-making authority.
■ Physical Custody: Dictates where the child lives.
■ Joint Physical Custody (less common): The child splits time equally between both parents.
■ Sole Physical Custody: The child primarily resides with one parent.
10. Who May Consent to Treatment of a Child When Parents Are Divorced or Divorcing
● Who Can Consent:
○ At least one legal custodian may provide consent for therapy.
○ If both parents share joint legal custody, therapists are advised to obtain consent from both custodians to avoid conflict, although only one is legally required.
● Considerations for Conflict:
○ If there is visible conflict between parents, it’s prudent to secure both consents, even though not mandatory.
○ For married parents (even if separated), only one parent's consent is legally needed unless disagreement arises.
● Court’s Criteria for Custody Decisions:
○ Custody decisions are based on the best interest of the child, aiming for both parents to maintain contact with the child where possible.
Kathy emphasized that the legal complexities of joint custody disagreements or nuanced definitions of "best interest" won't be part of multiple-choice questions.
Answer for Subpoenas (Question 11):
When responding to a subpoena as a therapist:
Claim Privilege: Your first response should be to claim the privilege of confidentiality on behalf of the client. Do not release any information until it has been legally clarified whether privilege applies.
Verify the Subpoena: Check if the subpoena is valid and enforceable. For instance, it must be properly issued, and for email subpoenas, the recipient must have previously given written consent to accept them via email.
Consult Guidance: If you’re a pre-licensed therapist, immediately consult your supervisor. If licensed, consult with legal resources such as CAMFT or an attorney specializing in mental health law to determine how to proceed.
Client Consent: If the client signs a Release of Information (ROI) specifying what can be disclosed, you can provide the information outlined.
Handle Without Acknowledgment: If no ROI exists, do not acknowledge whether the individual named in the subpoena is your client. Respond with language such as:
"This office/practice cannot confirm or deny the existence of a client relationship due to confidentiality and privilege requirements."Check for Exceptions: Familiarize yourself with exceptions to privilege, such as when a client introduces their mental health as part of a legal proceeding.
12. Scope of Practice vs. Scope of Competence
Scope of Practice: Refers to what the law allows a licensed professional to do based on their profession.
○ Example: MFTs can assess, evaluate, and treat relational issues, emotional disorders, and substance abuse. However, they cannot provide medical advice or prescribe medications, as these are outside their legal scope.
Scope of Competence: Refers to what a professional is specifically qualified to do based on their education, training, and experience.
○ Example: While it is within the MFT scope of practice to provide trauma therapy, a therapist who has not received training in trauma-informed approaches may lack the competence to effectively treat trauma.
The scope of competence is narrower than the scope of practice. Professionals must continually evaluate their training and experience to determine their competence and refer clients when a case exceeds their abilities.
13. What is a dual or multiple relationship?
Definition: A dual or multiple relationship occurs when a therapist has another significant role with a client outside the therapeutic relationship (e.g., friend, business partner).
● Examples of unethical multiple relationships:
○ Sexual relationships (illegal and always unethical).
○ Borrowing money from a client.
○ Entering a business relationship with a client.
○ Providing therapy to a close personal friend.
○ Engaging in a relationship that exploits the client or impairs the therapist's judgment.
● Ethically permissible multiple relationships:
○ Living in a small town where overlapping roles may occur, provided no harm or exploitation results.
○ Overlaps in life that do not impair professional judgment or exploit the client.
Key ethical principles:
● Evaluate whether the relationship could harm the client or impair professional judgment.
● Avoid relationships that could cause exploitation or damage.
Exam Note:
● Focus on clear examples of unethical relationships (e.g., borrowing money, business relationships).
● Situations that are too vague or require splitting hairs (e.g., defining “close personal friend” precisely) will not be tested.
14. Therapist's obligation if a client reports a sexual relationship with a former therapist
● Actions required:
○ Provide the client with a brochure titled "Therapy Never Includes Sexual Contact" (available on the BBS website).
○ Encourage the client to report the incident to the licensing board but recognize this is their choice.
● Additional considerations:
○ If the client is under 18, this is considered child abuse and requires a mandatory report.
○ For adult clients reporting past abuse, reporting is only required if there is reason to suspect the abuser is currently in contact with children.
15. Deciding whether to see a client who is also seeing another psychotherapist
● Relevant standard: CAMFT Ethical Standard 5.12: Duplication of Therapy.
○ Therapists must carefully evaluate the client's needs and potential conflicts.
○ Discuss with the client their current relationship with the other therapist.
○ Consider consulting with the other psychotherapist.
Exam Note:
● Expect a test question directly related to CAMFT Standard 5.12.
16. Laws and ethical standards around financial issues and advertising
● Key financial ethical standards:
○ Full disclosure of fees to clients.
○ No referral fees (cannot pay or accept payment for client referrals).
○ Guidelines on bartering: discouraged but not prohibited if the arrangement is non-exploitative and clear.
○ Pro bono work: encouraged but not required to offer sliding scales or free services.
○ Non-payment by the client: therapists can terminate treatment but must provide referrals and cannot withhold client records.
● Advertising guidelines:
○ Must not make false or misleading claims about services.
○ Be transparent in advertising fees and qualifications.
● Insurance billing:
○ Must accurately represent services provided.
○ Example of unethical behavior: splitting couple therapy billing into two individual sessions under separate insurances.
17. CAMFT Ethical Standard 3.9
● Key points:
○ Prohibits exploiting the therapeutic relationship for personal gain or advantage.
○ Emphasizes the importance of professional boundaries.
● Clinical significance example:
○ A therapist avoids asking a client to participate in a personal project that benefits the therapist.
18. Legal/ethical requirements when clients are involved in domestic violence
● Responsibilities:
○ Address safety concerns and create a plan to protect the client.
○ Be aware of mandatory reporting laws if children or dependent adults are involved.
○ Understand the legal requirements for confidentiality when dealing with violent situations.
19. Confidentiality in group therapy
● Key considerations:
○ Confidentiality applies to group therapy as it does to individual therapy.
○ Educate all participants about the importance of maintaining confidentiality.
20. Confidentiality in family therapy
● Relevant standards:
○ CAMFT Standard 2.2: Requires clear agreements about confidentiality and how information will be shared among family members.
○ AAMFT Standards 2.1 and 2.2: Emphasize the need for clarity and consent when disclosing confidential information.
Exam Note:
● Focus on the basics of confidentiality agreements and clear communication in group and family therapy settings.
General Notes:
● Ethics involve judgment calls and subjectivity, particularly in non-sexual multiple relationships.
● Sexual relationships are the only ones explicitly illegal, and a two-year waiting period applies after therapy ends.
● Non-sexual post-therapy relationships (e.g., business partnerships) are not explicitly prohibited but should be approached cautiously.
● Some specific nuances (e.g., psychoeducation vs. therapy) will not be on the exam.
21. Differences and Similarities Between LMFTs, LCSWs, and LPCCs
● Key Points
○ LMFTs focus on relationships and marriage therapy.
○ LCSWs specialize in community resources and systemic interventions.
○ LPCCs do not have a distinct "special thing" compared to LMFTs or LCSWs.
○ Psychologists focus more on testing.
○ Psychiatrists can prescribe medication (LMFTs cannot).
● Not on Exam: Specific details about differences in professional focus.
22. Professional Organizations for California MFTs
● Organizations
○ CAMFT (California Association of Marriage and Family Therapists)
■ Focuses on advancing individual member interests.
■ Provides California-specific legal advice.
■ Acts like a union for MFTs and others.
■ Allows romantic relationships with clients two years post-therapy (per CA law).
○ AAMFT (American Association for Marriage and Family Therapy)
■ Focuses on advancing the profession as a whole.
■ Publishes a peer-reviewed journal.
■ No romantic relationships with clients post-therapy.
● Key Difference: CAMFT is state-focused; AAMFT is national.
● Not on Exam: Specific ethics rules about romantic relationships.
23. Legal and Ethical Requirements for Clinical Record-Keeping
● Retention Period
○ Keep records for at least 7 years.
○ For minors, retain records for 7 years after they turn 18 (age 25).
● Format
○ No specific format required; must align with sound clinical practices.
24. Regulatory and Ethical Standards for Telehealth
● Training Requirements
○ 3 hours of telehealth training required.
○ Document training completion.
● Session Requirements
○ Ask the client:
■ "Where are you?" (location).
■ "Are you safe?" (crisis suitability).
■ "Is telehealth still appropriate?"
○ Use HIPAA-compliant platforms.
● Informed Consent
○ At the start: Explain telehealth limitations (e.g., internet issues, privacy risks).
● Licensing
○ Client must be in California during sessions.
○ Therapist can be out of state if eligible to work in California.
25. Licensing Requirements for LMFTs in California
● Details
○ Must meet specific examination and experience requirements.
○ Ratio: 5 supervisees to 1 supervisor after graduation.
● Not on Exam: Licensing details or ratio rules.
26. Ethical Standards on Giving/Receiving Gifts
● Guidelines
○ Not forbidden but requires careful consideration of:
■ Financial value (should not be exploitive).
■ Meaning within the therapeutic relationship (often culturally influenced).
27. Ethical and Legal Guidelines for Client Contact in Emergencies
● Requirements
○ Inform clients how emergencies will be handled (per informed consent).
○ No obligation to provide:
■ An answering service.
■ On-call availability.
● Best Practice
○ Include emergency instructions in voicemail (e.g., "Call 911 for emergencies").
28. Laws/Ethical Standards on Giving Advice for Significant Life Decisions
● Guidance
○ Ethical standard: Respect client autonomy (e.g., decisions about marriage, divorce, jobs).
○ Therapists should not give advice on significant life decisions.
