front 1 Therapeutic Relationship: Recommendations & Resolutions | back 1 - Consider the client’s best interest and potential impact of any
of the counselor’s actions
- Use the counselor/client
relationship to model healthy interactions
- Treat clients
with respect
- Earn trust by protecting privacy
- Consider the role and impact of personal beliefs and values
- Consider the role of diversity
- Attempt to give time for
pro bono work
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| back 2 the primary responsibility of the counselor. In order to keep client
dignity at the forefront, the counselor needs to keep the client’s
interest in focus |
front 3 Client Welfare: Potential Issues | back 3 - The counselor focusing on their own needs and interests at the
expense of the client
- Temptation to disrespect the client
when facing a tense or argumentative situation
- Lack of
attention to the client’s background or cultural diversity
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front 4 Client Welfare: Recommendations and Resolutions | back 4 - Consider the impact of client interactions
- Communicate
respectfully at all times
- Double check all your actions to
ensure that they are consistent with best practices
- Communicate with the client on their terms
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front 5 Records and documentation | back 5 - key to safeguarding confidentiality and maintaining integrity
in the relationship, accurately reflecting treatment and
process.
- Accurate record keeping allows the counselor to
abide by appropriate laws, keep the process going seamlessly,
communicate with colleagues, smooth re-entry for a returning client,
and facilitating a transfer of a client.
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front 6 Records and documentation: Potential Issues | back 6 - Temptation to delay documentation, letting memories fade
- Failure to anticipate the multiple uses of records
- Adding notes that were not part of session, failing to stick
only to the facts
- Disposing of records prematurely
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front 7 Records and documentation: | back 7 - Create, keep, and protect records at all time
- Consider
all potential uses
- Pay close attention to confidentiality
issues
- Note the process clearly without additions or
omissions (if amendments must be made to a record, these must be
made in accordance with agency or institutional policy)
- Include the rationale for treatment
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front 8 Counseling Treatment Plans: Potential Issues | back 8 - Failure to assess the client’s needs, strengths, and goals
- Setting unreasonable goals
- Selecting goals and
developing a plan without involving the client
- Failure to
reassess and update the plan
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front 9 Counseling Treatment Plans: Recommendations and Resolutions | back 9 - Goals should be thoroughly assessed at the beginning of the
relationship and be constantly re-evaluated
- Plans should be
constantly re-assessed, working with both the counselor’s and the
client’s needs and strengths into account
- Developing a plan
should be a collaborative process that takes the client’s and the
counselor’s wishes into account
- Constantly attend to
factors that may affect the process, including motivation, level of
support, and financial factors
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front 10 support network and treatment | back 10 Involving the client's support network can make or
break the treatment process. When possible the counselor should enlist
aid from the client’s network, facilitating the building of relationships. |
front 11 Support Network: Potential Issues | back 11 - Assuming the counseling relationship is all that the client
needs
- Failure to help clients reach out for other
support
- The temptation to assume how the relationships in a
client’s life will affect them
- Becoming defensive about the
involvement of other relationships
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front 12 Support Network: Recommendations and Resolutions | back 12 - Consider the support network as a means for buffering the
counseling relationship
- Openly discuss resources and how to
enlist help from others
- Monitor the effectiveness and value
of the support network
- Only contact support with the
client’s permission
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| back 13 - gives clients the freedom to choose throughout the counseling
process. It is the counselor’s job to make sure the client has
accurate information and documentation throughout the process.
- a continuous process and lets clients make decisions with all
the information in front of them.
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front 14 Informed Consent: Potential Issues | back 14 - Having the client sign forms without discussing and
explaining
- Viewing the client's questions as intrusive
- Seeing informed consent as a burden
- Taking an
authoritarian approach may make the client feel like they have less
freedom to make their own choices
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front 15 Informed Consent: Recommendations and Resolutions | back 15 - Recognize the importance of informed consent
- Make sure
that consent is freely given
- Ensure that clients have all
the information needed to make a decision
- Share information
verbally and in writing
- Update on a continuous basis
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front 16 Types of information included in informed consent | back 16 - purposes, goals, techniques, procedures, limitations, risks,
and benefits. It also includes the counselor’s credentials,
experience, approach, backup plans, and any other pertinent
information. It also includes billing information and arrangements.
All of this information must be shared freely and explicitly.
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| back 17 - look into the ethics of getting consent from an incapacitated
adult or from a child.
- Even if a client is not capable of
giving consent they should still be informed of their situation and
their rights. Counselors should always be up to date on current laws
about consent and incapacity.
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front 18 Ability to Give Consent: Potential Issues | back 18 - - Sharing information only with guardians
- Failure to
involve clients in the decision-making process
- Confusion
about who the actual client is
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front 19 Ability to Give Consent: Recommendations and Resolutions | back 19 - Clarify each person’s legal rights
- Include each client
in the process as much as possible
- Make sure voluntary
consent is given before the counseling process starts
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front 20 Mandated Clients: Potential Issues | back 20 - Mandated clients may not care about the process
- Clients may not understand the confidentiality rules
- Clients may not know they can refuse to participate
- Counselors may assume they need to persuade clients to
participate
- The counselors might attempt to persuade the
client to accept for their own financial gain
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front 21 Mandated Clients: Recommendations and Resolutions | back 21 - Be extra mindful of the need for informed consent
- Take
extra care at the beginning of the process to make sure the client
understands all the details of the process
- Make sure that
clients understand their right to decline to be involved in the
process
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front 22 Therapist's Personal Values: Potential Issues | back 22 - - Lack of awareness of personal values
- Failure to
think about the impact of statements on the client
- Holding
strong values that could adversely affect the client
- Forgetting that trainees and interns require the same
sensitivity as clients
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front 23 Therapist's Personal Values: Recommendations and Resolutions | back 23 - Consider the impact of any action on others before taking
it
- Take part in ongoing self-reflection
- When
personal values conflict with the client’s be very mindful about
sharing them
- Be careful about doing anything in conflict
with the pre-set treatment goals
- Be respectful of
diversity
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front 24 Counselors are prohibited from: | back 24 1. Having sexual relationships with current clients or from accepting
a client with whom they have previously had a sexual relationship.
2. Having a sexual relationship with former clients for at
least 5 years after the counseling process has concluded;
there must be a written agreement demonstrating that the relationship
is non-exploitative.
3. Having relationships with friends and family members if there is
an inability to remain objective.
4. Having personal virtual relationships with current clients. |
front 25 Sex and Clients: Recommendations and Resolutions | back 25 - Keep healthy boundaries and self-care
- Always think
about how entering a relationship will affect client care
- Keep appropriate boundaries with the client’s support
network
- Realize that commitment to the client’s well-being
does not end when the professional relationship ends
- Pay
attention to warning signs
- Refer friends and family to
professional help when necessary
- Ensure that new clients
are informed about professional communication and relationships
- Seek colleague consultation if you are struggling with romantic
feelings about a client
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front 26 Multiple Relationships: Potential Issues | back 26 - It is tempting to try to help a former acquaintance
- Refusing to avoid a counseling relationship with
anyone the counselor has ever known previously
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front 27 Multiple Relationships: Recommendations and Resolutions | back 27 - Carefully consider taking any client which you have previously
known
- Weigh the potential risks and benefits
- Carefully discuss the pros and cons with the potential
client
- If unsure, consult colleagues or other
professionals
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front 28 Extending Professional Boundaries | back 28 - such as attending weddings and funerals of clients and their
network (secondary relationships).
- Sometimes these
extensions of boundaries are necessary and helpful. These extensions
should be carefully documented and take into account state
laws.
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front 29 Extending professional boundaries: potential issues | back 29 - Failing to consider the potential impact of these relationships
could result in damaging relationships with clients
- Desire
to keep relationships secret
- Placing counselor needs about
client needs
- Counselors living in remote areas are more
likely to engage in secondary relationships
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front 30 extending professional boundaries: recommendations and resolutions | back 30 - Only enter a secondary relationship if it is advisable and
there are no laws or policies against it
- Use a thoughtful
decision making process
- When unsure about appropriateness,
consult colleagues
- Document the rationale and decision
making process
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| back 31 - takes place the counselor must update informed consent with the
client. This role change may include change between individual or
family counseling, changing from evaluation to therapy, or changing
from a counselor to a mediator.
- Any role change must be to
the benefit of the client.
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front 32 Role Change: Potential Issues | back 32 - Shifting roles without discussing with the client
- Failure to consider the potential impact
- Changing roles
without careful consideration of incompatibility with other
roles
- Forgetting to maintain professional boundaries
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front 33 Role Change: Recommendations and Resolutions | back 33 - Consider the client’s best interests
- Engage in
informed consent processes before any changes are made
- Provide adequate information to the client
- If the
client’s needs go beyond your ability, refer them to another
professional
- Never change roles for personal benefit
- Steer clear of nonprofessional interactions
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front 34 Advocate: Potential Issues | back 34 - Failure to see opportunities for client advocacy by placing
yourself in a limited role
- Being overzealous in advocacy
may undermine the client’s autonomy
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front 35 Advocate: Recommendation and Resolutions | back 35 - Honor overarching obligation to society as a whole
- Only engage in advocacy with the client’s informed consent
- Advocacy should be motivated by the client’s needs, not the
counselor’s personal needs
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front 36 Counseling Multiple Clients | back 36 - Sometimes counselors provide care to clients who are in a
relationship. In this case it is important for roles and
relationships to be made clear.
- All professional roles
should be clarified from the beginning of the relationship.
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front 37 Counseling Multiple Clients: Potential Issues | back 37 - Overlooking the potential for lack of objectivity
- Failure to openly talk about the roles of all affected
clients
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front 38 Counseling Multiple Clients: Recommendations and Resolutions | back 38 - Careful consideration of the needs of the multiple client as
individuals and in their relationships
- Closely and
continuously monitor the impact of the process on all clients
- When concerns come up, openly discuss them with all clients
- Before counseling begins, consider all options
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front 39 Group Counseling: Potential Issues | back 39 - Attending to the needs of the group may cause a counselor to
overlook the individual
- Challenge of overlooking the
potential harm of group work
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front 40 Group Counseling: Recommendations and Resolutions | back 40 - Ensure competency in group work
- Carefully screen
clients
- Attend to informed consent
- Be clear about
expectations and confidentiality
- Take active precautions to
minimize harm
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front 41 setting fees: recommendations and best practices | back 41 - Address all fees and payment issues in the informed consent
process
- Consider community standards for reasonable fees
- Maintain a list of other professionals to give the client
options
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front 42 Bartering: Recommendations and best practices | back 42 - may only take place if it does not result in harm to the
client. It should only take place with a clear and written
contract
- Remain open to the possibility that bartering may be
the only option for some
- Reach an agreement in advance
- Monitor the impact on the client
- Be sure the client’s
best interests are met
- Periodically revisit the
agreement
- Seek the opinion of a colleague
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front 43 Determining whether to accept a gift: Recommendations and Resolutions | back 43 - Never suggest gift giving
- Explore the meaning of the
gift
- Consider whose needs are being served and make decisions
based on the needs of the client
- Be mindful of client
vulnerabilities
- Do not suggest that gifts are expected
- Consider cultural factors
- Consider whether the gift
will impair your judgment
- consider cultural and personal
implications as well as personal motivation from both the counselor
and the client.
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front 44 When termination is appropriate | back 44 1. The client no longer needs counseling 2. The client is no
longer benefiting from counseling 3. The client may be harmed if
counseling continues 4. The client no longer pays the agreed upon
fees 5. The client or someone with whom the client has a
relationship poses a threat to the counselor |
front 45 Client-Motivated Reasons for Termination: | back 45 - These may include the client meeting his/or her goals, running
out of insurance benefits, financial limitations, a move from the
area, a decision to transfer to a new counselor, or just deciding to
stop the counseling process.
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front 46 Counselor-Motivated Reasons for Termination: | back 46 - lack of competence, lack of client progress, boundary or
relationship issues, conflicts or threats from the client, lack of
availability to meet your client’s growing needs, illness,
disability, death, or retirement. It might also be the end of a
training experience.
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front 47 Terminating: Recommendations | back 47 Planning for and openly discussing the end of the relationship with a
client is a critical part of the counseling process. These are a few recommendations:
- Openly discuss termination with clients: allow enough time
for planning and processing, allowing clients to move forward in
life
-
Never abandon a client: do not stop service
abruptly; keep clients thoroughly informed of procedures
- Cooperate fully in the client transfer process: if the client is
changing counselors, help by recommending other professionals and
keep open communication, including transferring records or other
requested information
- Address insurance coverage issues up
front: make sure the client knows limitations at the beginning of
therapy
- Carefully manage abrupt endings: if the client ends
things abruptly, try to create a smooth transition; if the client is
a high risk for harm or suicide, follow up with ethical
obligations
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front 48 Abandoning a Client: Recommendations | back 48 - Termination or referral must include informed consent
- Be sensitive to feelings of abandonment
- Be
knowledgeable about community resources
- Make appropriate
coverage arrangements during an absence
- Seek additional
training
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| back 49 gender, age, race, depression, alcohol, impulsivity, history of
attempts, family history, chronic illness, hopelessness, helplessness,
loss, psychosis, lack of social support, and having a plan and the
means to carry it out. |
| back 50 talking about suicide, verbal cues, self-neglect, worsening mood,
sudden loss, sudden changes in mood, suicidal planning, withdrawal,
preparations, and saying goodbye. |
| back 51 - refers to the variety of insurance companies that help
facilitate health care.
- Insurance approves care based on
several factors and is often a major factor in a client's decision
to take on counseling.
- Managed care can be essential for
allowing a client to enter counseling, but it also presents
challenges to counselors in a number of forms.
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front 52 Progress Notes vs. Psychotherapy Notes | back 52 - a client’s mental health records (also called progress notes)
and psychotherapy notes (also called process or private notes).
- progress notes, include information regarding assessment
results, treatment plan, symptoms, and a summary of the client’s
progress in therapy. The client has a legal right to access progress
notes.
- Psychotherapy notes, on the other hand, include the
therapist’s observations as well as thoughts and feelings related to
the session. These are the therapist’s personal notes and they get
special protection under the HIPAA Privacy Rule because they often
contain sensitive information. On a federal level, the client does
not have a legal right to access psychotherapy notes.
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front 53 What’s Included in the Client Records? | back 53 - Name - Contact information, including emergency contact -
Fees and billing - Informed consent documentation - Releases
of information - Mandated disclosures (ex. child abuse report,
court ordered releases) - Reason for service (presenting issue,
diagnosis) - Treatment plan - Certain history, such as
medical, family, or developmental
Each time you are in contact with the client:
Date of service and length of session - Type of service
(assessment, treatment, consultation, etc.) - Type of
professional contact (treatment modality -
individual/group/family/couples, referral, letter, e-mail,
etc.) - Client’s current mental status |