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Discuss elements of the Tarasoff Case
Psychologist treating patient who made a threat toward a women. He attempted to commit patient but failed to do so. Patient dropped out of therapy. Supervision forbade Doc to take anymore steps to proctect intended victim. Patient kills victim. Parents of victim sued. 1974;1976 State of California rule duty to warn/to protect resp.
What are the three criteria that must be met to meet the requirements of Tarasoff?
assessment, development of treatment plan, and implementation of treatment plan.
List the eight steps you should take to constitute reasonable care to protect an intended victim.
- 1. Develop intervention plan to diffuse danger
- 2. Commit patient
- 3. Medication referral
- 4. Shift to family therapy
- 5. Request to remove weapons
- 6. Increase frequency of therapeutic contact
- 7. Warn victim
- 8. Inform patient of your duty to protect/warn victim
Name the court case which indicated that Tarasoff does not apply to suicide.
Bellah v. Greenson (1978)
- S: Sex. Men are more likely to commit suicide than women. Males kill themselves aboutfour times more often, although females make far more attempts.
- A: Age. The ages which are most dangerous for suicide vary over time. You shouldconsult current statistics. As this is being written in 2006 individuals 1524have anelevated risk. Suicide is the third leading cause of death in this age group. However,estimates exist which suggest that people this age making attempts outnumber actualsuicides by a ratio of 100400times.Males over age 75 are also known to be at high risk. Current demographics suggestthat women in the 4554age group are highest, but females in older or younger ageranges are not that different. After age 65 individuals as a whole have an attempt tocompleted suicide rate of about 2:1. Up to age 65, it is about a 7:1 ratio.
- D: Depression. The suicide rate for those who are clinically depressed is about 20 timesgreater than for the general population. Hopelessness is one aspect of depression thathas a close tie to suicide. These two issues, depression and hopelessness, are thestrongest predictors of wishes for a hastened death.
- P: Prior History. Roughly 80% of completed suicides were preceded by a prior attempt.
- E: Ethanol abuse. Alcohol and/or drug abuse increase risk.
- R: Rational thinking loss. Psychosis (‘I heard a voice saying I should kill myself’)increases risk. Some estimates suggest that 2040%of schizophrenics make anattempt at some point, and the risk is highest early on in the illness.
- S: Support System Loss. Loss of support can vary tremendously. With kids andadolescents it can be the break up of their first ‘puppy love’ which they can takevery seriously even though others like parents may view it as a trivial event. Other lostrelationships for adolescents can include parents divorcing and remarrying someone else. Even a parent who is divorced or separated and living with a new person can be atrigger for adolescent suicide. The death of a relative, such as grandparents,can beanother trigger for kids.Loss of a spouse can be devastating to some. Loss of a parent within the past 35yearsincreases risk of suicide. Among older individuals, men who are widowed, andwomen who are divorced or separated are at increased risk
- O: Organized Plan. This speaks for itself. Having a method in mind creates more risk.
- N: No Significant Other. See ‘S’ above.S: Sickness. Terminal illness, such as cancer and AIDS, also carries with it a 20 foldincrease in risk of suicide compared to the general population.
Define privilege communication
- a. legal concept that generally bars the
- disclosure of confidential communications in a legal proceeding. Therapist can refuse to answer questions in court or refuse to produce a client’s records in court – this privilege belongs
- to the client and is not designed to protect the MHP.
- Privacy: as related to the law refers to
- the constitutional right of an individual to decide the time, place manner, and extent of sharing oneself with others.
There are some exceptions to the confidentiality
and privacy issues that I provided in class.
List these exceptions
Does not generally apply to (a) couples, (b) group work, (c) family therapy.
No clear judicial trend has been set forth regarding disclosures which happen in the presence of 3rd parties.
- Good policy to inform clients about confidentiality and its expectations from the beginning and to
- continue to discuss.
What are the mandated exceptions to confidentiality and privacy?
suspected abuse or neglect
Define competence. What are the three
basic factors related to competence?
Competence generally refers to the quality of having adequate or better ability toperform some task physically, intellectually, emotionally, or otherwise
What is vicarious liability?
the responsibility of the superior for the acts of their subordinate, or, in a broader sense, the responsibility of any third party t
Define licensing boards. What are the
ESTABLISHED BY THE STATE. Members typically include members of profession as well as generally one or two public members.
- Complaint received then it is investigated by an
- investigator who determines whether or not it is worthy of pursuit
- Standard is whether or not the licensing law, it
- regulations, or other laws violated
- Standards less stringent, not criminal; rather
Elements of a professional will
include comprehensive instructions for designating professional executors who are available to respond to immediate client needs for transfer or referral. identify a person separate from the professional executor to manage disposition of records; include notifying clients,answering questions, and transferring, maintaining, and finallydisposing of records.
Argument for utilizing a diagnosis as part of
Arguments against utilizing a diagnosis as part of treatment plan
Fact vs. Expert witness
- A fact witness is a person with knowledge about what happened in a particular case, who testifies in the case about what happened or what
- the facts are. Fact witness testimony consists of the recitation of facts and/or events as opposed to an expert witness, whose testimony consists of the presentation of an opinion, a diagnosis, etc.
- An expert witness is not called to testify because of prior involvement in activities that precipitated the litigation. The expert testifies because he or
- she has knowledge, skill, experience, training, or education, and has expertise that may be meaningful to a party in attempting to prove its side of the case.
- An expert testifies voluntarily by agreement with one of the parties or the court.
- A key distinction between fact witnesses and expert witnesses is that an expert witness may provide an opinion and is entiteled to compensation.
The primary purpose of a deposition is to _______________________________.
Secondary purposes of depositions include ______________________________.
discover info that leads to evidence.
to preserve a witness's recollection while it is still fresh and compare to live testimony in court.
If you are subpoenaed or your records are
subpoenaed, you should take the following steps
determine whether the subpoena is court ordered or ordered by a lawyer and then act accordingly.
- Court ordered subpoens must be honored.
- If lawyer initiated, seek client's permission to authorize release of information.
After receiving a subpoena therapists should carefully determine its validity, who initiated it and whether it is in fact a court order.
therapist should release only the relevant and the minimum necessary information
Define Mens RaeMens
Rae distinguishes between acts that are… basically four levels including (purpose, knowledge, recklessness, and negligence).
- refers to the level of criminal intent required for a
- criminal offense. The purpose of considering mental state is to distinguish between acts that are inadvertent, accidental, or committed by those who are incapable of forming the intent to commit the action AND those acts performed by someone with a “guilty mind.”
Competency to stand trial (definition)
- The court, attorneys or social agencies may ask for an evaluation of a defendant's mental condition at the time of trial. A legal judgement about the ability of a defendant to understand the
- legal proceedings and instruct and consult with counsel in their own
Who can raise the issue of competency?
court, attorneys or social agencies
What are the two prongs of competency?
- (1) a factual understanding of the proceedings, not just the charges;
- (2) a functional ability to assist one's attorney in one's own
Define Diminished Capacity.
- In some jurisdictions, this defense reduces the degree of
- the crime for which a defendant’s conduct satisfies all of the formal elements
- of a higher offense. In most states, the
- diminished capacity concept allows a defendant in a criminal case to introduce evidence of mental abnormality at trial to negate a mental element of the crime charged.
How is the term insanity different from competency?
Insanity focuses on the defendant’s mental state at the time of the offense charged. Competency, in contrast, focuses on the defendant’s mental state at the time he or she is interrogated, at trial, sentencing, oral execution.
- Basically the “ability to distinguish between the moral and legal right and wrong.” “Not know the
- nature and quality of the act.”
What is the M’Naghten Rule?
- Court presumes that every criminal is sane – if it is questioned then the STATE must
- prove that the individual was sane
Describe the concept of the “irrestible impulse.”
is a defense by excuse, in this case some sort of insanity, in which the defendant argues that they should not be held criminally liable for their actions that broke the law, because they could not control those actions.
Mental Retardation and criminal responsibility.
Describe the clinician’s responsibilities as they relate to provision of assent to children.
Children’s capacities to make decisions, including those related to settingtreatment goals, vary as a function of their developmental level and legalstandards. Psychotherapists should take these differences into account whenobtaining consent, permission, and assent during treatment. The assent of children is not necessary but the child's refusal should be respected.
What are some ethical issues concerning provision of services to adolescents?
Adolescents should agree to treatment. If not, may either resent the treatment given or refuse treatment later in life based on their early experiences.
How does the court determine competency of a witness?
lack of personal knowledge or mental incapacity.
- mental illness, the relevant determination is whether the witness "understands the obligation of an oath and is capable of correctly
- relating the facts to which the testimony relates
A competent witness must:
A competent witness must: (1) be of sound mind (2) have first-hand knowledge/relevant evidence (3) be sworn.
the competence of a witness depends upon the capacity ofthat witness to observe, to remember, to communicate, and to understandthe nature of the oath and the duty it imposes to tell the truth
What are the four elements of self defense and how do these relate to the battered women’s syndrome?
- expert testimonyone acting in self-defense must believe another person intends to use
- unlawful force against him. Second, that belief must be reasonable.
- Third, the threat must be imminent. Fourth, the amount of force used
- must be proportional to the threat.
- procedure for investigating a person's death by reconstructing what the person thought, felt, and
- did preceding his or her death. This reconstruction is based upon
- information gathered from personal documents, police reports, medical and
- coroner's records, and face-to-face interviews with families,
- friends, and others who had contact with the person before the death.
- Read more: Autopsy, Psychological - body, life, cause, person http://www.deathreference.com/A-Bi/Autopsy-Psychological.html#ixzz1KeQ4FQSl
Basic purpose of ethical practice
- to provide general guidelines for mental health
to safeguard the welfare and safety of the clients
licensure vs. certification
- Licensure is a non-voluntary process by which an agency of government regulates a profession. It grants permission to an individual to engage in an occupation if it finds that the applicant has attained
- the degree of competency required to ensure the public health, safety, and welfare will be reasonably protected. Licensing it always based on
- the action of a legislative body. Once a licensing law has been passed it becomes illegal for anyone to engage in that occupation unless he or she has a license. The health care professions are typically licensed at the state and/or local level, but not usually at the federal level.
offered by a private, non-governmental agency. voluntary. used to acknowledge has met a standard
- Ethics: refers to
- the standards that govern the conduct of professional members whereas
- Laws: refers to the body of rules that govern the
- affairs of people within a community. You respond differently if it becomes a legal
- issue rather than an ethical issue.
- beliefs and attitudes that provide direction to everyday living. Differ from ethics which are beliefs about what is the correct way to conduct oneself
- perspectives of right and proper conduct and involves evaluation of actions on the basis of a broader cultural context or religions standard
- Professionalism: this term is related to ethical
- behavior but you can behave in a way that is unprofessional without being
- form of civil law whereby parties who are injured in professional relationship may seek $ for damages.
- Duty – professional duty
- Damage – damage to client or patient
- Deviated – deviation from minimal or acceptable norms
- of practice
- Direct- link between damage to patient and behavior or
Legal aspects of Informed Consent
- (1) capacity: client has the ability to make rational
- decisions, (2) comprehension of the information: therapist must give the
- clients information in a clear and concise way and make sure that clients understand
- it, (3) Voluntariness: means that the person giving consent is acting freely in
- the decision making process. They must
- be legally and psychologically able (competent) to make the decision.
A multiple relationship occurs when a psychologist
- is in a
- professional role with a person and (1) at the same time is in another role
- with the same person, (2) at the same time is in a relationship with a person
- closely associated with or related to the person with or related to the person
- with whom the psychologist has a professional relationship, or (3) promises to
- enter into another relationship in the future with the person or a person
- closely associated with the person with whom …
What Happens Outside the Psychotherapy Session Has Nothing to Do With the Therapy
Crossing a Boundary With a Therapy Client Has the Same Meaning as Doingthe Same Thing With Someone Who Is Not a Client
Our Understanding of a Boundary Crossing Is Also the Client’s Understandingof the Boundary Crossing
A Boundary Crossing That Is Therapeutic for One Client Also Will BeTherapeutic for Another Client
Boundary Crossing Is a Static, Isolated Event
If We Ourselves Do Not See Any Self-Interest, Problems, Conflicts ofInterest, Unintended Consequences, Major Risks, or Potential Downsides to Crossing aParticular Boundary, Then There Aren’t Any
Self-Disclosure Is, Per Se, Always Therapeutic Because It Shows Authenticity,Transparency, and Trust
What is the problem of balanced confidentiality
and how might it be resolved? (From Bennett article, “Balancing Confidentiality: Protecting
Privacy and Protecting the Public.”
whendisclosure of confidential information is unavoidable, should provideonly the minimal amount of information necessary in order topreserve privacy to the fullest extent possible.In order to achieve the objective of treating confidentiality as theprimary ethical obligation, psychology must more actively assertthe position that without confidentiality, psychologists cannot be effective.
What is the primary ethical obligation for
to provide general guidelines for mental healthprofessionalsto safeguard the welfare and safety of the clients
forensic evaluation and psychotherapy
- In a forensic evaluation, the mental health professional
- who performs the assessment examines each possible explanation for the
- patient's symptomatic presentation. Data is collected and each hypothesis
- is weighed in the light of supportive and disconfirming data. None of the
- possibilities should be given precedence in the initial stages of the process.
- At some point, the evaluator forms an opinion and uses the data to support
- his or her formulation in court.
- the patient presents his or her history and symptoms
- to the therapist, who generally accepts the account at face value. No attempt
- is made to test or disconfirm the implicit hypothesis that the patient's
- account of events is accurate. The basis of successful psychotherapy is
- a trusting relationship between therapist and client. Since any attempt
- by a therapist to verify or disconfirm the patient's version of events
- would probably destroy this trust, treating therapists rarely attempt to
- assess the possibility of false imputation or malingering.
Koocher article, “Ethical Challenges to Clinical Services to Children and
de facto and de jure incompetence?
Consent versus assent
Limits of Confidentiality when working with children and familiies.
What are necessary secrets and how are they best handled during the informed consent
- de facto and de jure incompetence
- de facto (i.e., actual) and de jure(under the law) incompetence (Koocher & Keith-Spiegel, 1990). The legal systempresumes adults to be competent, but considers people who have not yet reached theage of legal majority incompetent de jure.
- Consent versus assent
Koocher argues that you should not release
records from individual meetings with parents if the child’s records are requested. How would one deal effectively with this problem? Does file/chart organization play a role here?
have parents pledge unconditional respect for their child’sconfidentiality at the outset of therapy.
Keep separate files or file sections for each party affords the simplest way to manage such problems.
Table 2, Page 616 article, “Ethics of
Advertising, Billing, and Practice in Psychotherapy.”
Honesty, nonmaleficence,respect for patient autonomy
nonmalefacience, beneficience, respect, autonomy
- Autonomy It is critical that you promote self determination, the right of others to make
- their own choices, and a focus on client growth and self-development
-This refers to the concept that you are professionally obligated to “do no harm” and to refrain from action that could risk hurting the clients.
- Refers to the concept of promoting good for others. Focus should always be on the growth and development of clients.
- Fairness to others and treating everyone equally. Equal access to mental health care is a key component of the concept of justice.
- Fidelity - Making promises and keeping them. Not making
- promises that you cannot keep. Refers to
- the concept of fulfilling your professional responsibilities and creating a
- Reflects truthfulness and the development of trust within the context of professional responsibility. Being transparent with clients.
appropriate record keeping
- Comprehensive (treatment plan, sufficient
- information to establish diagnosis, treatment plan, justification for treatment plan
- Documentaiton of consent
- Objectively written. Goals should be measured and achievable
- Records created with expectation patient will read
- them someday
Sources of information indicated
- Content related to treatment goals
NGRI – outcomes, burden of
GBMI – outcomes, burden of proof
Not guilty by reason of insanity, state burden of proof
- presumes that every criminal is sane – if it is questioned then the STATE must
- prove that the individual was sane
- If successful the trial judge will commit the person to
- state hospital for a period of not more than 120 days during which he is examined
- and determination made as to whether further hospitalization is needed.
- GBMI (Guilty but
- Mentally Ill) – Introduced in 1984 – purpose was to (a) reduce the number
- of defendents who were completely relieved from criminal responsibility and (b)
- ensure that mentally ill inmates receige treatment
- “Lacked sufficient capacity to conform his conduct to the
- requirements of the law”