No one wants to think about malpractice…I know I don’t! But we have to — it’s a risk that we take when we choose to enter a profession whose focus is helping others. One of the most important ways you can protect yourself against malpractice is through the process of informed consent. Of equal importance, this process also (hopefully) protects the client from inadvertently or unknowingly entering into a situation that could lead to uncomfortable emotions, pain, regression, etc.
Obtaining informed consent is a crucial part of the therapeutic relationship.
Test-makers and licensing bodies want to ensure that you will protect your clients — and this protection begins at the first moment of contact, often through the process of informed consent. Here’s one way it might come up on the exam:
A therapist has been working with a client with Borderline Personality Disorder for several months with minimal progress; the client has had periods of suicidal ideation, erratic and intense personal relationships, and is in danger of being fired at work due to an all-or-nothing attitude. The therapist is considering terminating with the client and referring the client to a new therapist, but would like to use her monthly consultation group to process the case. What should the therapist do FIRST?
A. Tell the client at the next session that the case will be discussed by the consultation group
B. Ensure that the informed consent provides for this disclosure
C. Proceed with the consultation while keeping identifying details of the client’s identity confidential
D. Explore the potential benefits of the consultation with the client at the next session
The NASW Code of Ethics gives the following guidelines regarding informed consent (this is not the entire text — for the entire text, visit: https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English): “Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a thirdparty payer, relevant costs, reasonable alternatives, clients’ right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions.” Similarly, in an article for CAMFT, Michael Griffin, J.D., LCSW, discusses the standards in the AAMFT’s Code of Ethics: “Marriage and family therapists obtain appropriate informed consent to therapy or related procedures as early as feasible in the therapeutic relationship, and use language that is reasonably understandable to clients. The content of informed consent may vary depending upon the client and treatment plan; however, informed consent generally necessitates that the client: (a) has the capacity to consent; (b) has been adequately informed of significant information concerning treatment processes and procedures; (c) has been adequately informed of potential risks and benefits of treatments for which generally recognized standards do not yet exist; (d) has freely and without undue influence expressed consent; and (e) has provided consent that is appropriately documented. When persons, due to age or mental status, are legally incapable of giving informed consent, marriage and family therapists obtain informed permission from a legally authorized person, if such substitute consent is legally permissible.” The full text of this article can be found here: http://www.camft.org/AM/Template.cfm?Section=Michael_Griffin&CONTENTID=10497&TEMPLATE=/CM/ContentDisplay.cfm
I’m going to admit here that I kind of agonized over this question — whether or not it really represented what I wanted it to, and whether or not I got the answer right myself! The best answer here, though, is B: ensure that the informed consent provides for this disclosure. In many cases, the section of the informed consent that deals with treatment processes and procedures (or the purpose of the services) contains a subsection that deals with supervision and/or consultation. Before the therapist takes any other step, she should ensure that the informed consent covers the consultation. If it does, then the therapist could proceed with A or D (D is probably a better option). If it doesn’t, the therapist would have to obtain consent to proceed with the consultation; C is not a good answer choice in either case. Whether you’re a social worker or a marriage and family therapist, whether you live in California or in another state, understanding your professional code of ethics is extremely important. TDC has incredible Law & Ethics exam prep materials that go much further than just reading the Code of Ethics — we actually focus on the application of the ethical standards to clinical situations. Preparing for licensure is, ahem, professional development!
Coming up next week: Confidentiality
Think our straightforward, sensible approach could help you PASS your social work or MFT exam? If you’re preparing for a social work exam, check out our Social Work Study Materials. If you’re preparing for an MFT exam, check out our MFT Study Materials. Learn more about our offerings at The Therapist Development Center.
Looking for more practice questions and some study tips? Check out our new Social Work Exam Study Guide:
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