Ethics in Child Therapy By Wynne Shaw, M.Ed., LPC-S Clinical Supervisor Dallas Children s Advocacy Center About DCAC The Dallas Children s Advocacy Center (DCAC) is a nonprofit agency that provides a coordinated, multi-agency approach to the investigation, intervention, and treatment of child sexual and physical abuse. Our mission is to improve the lives of abused children in Dallas County. About Me Master of Education in Counseling, UNT, 1994 Licensed Professional Counselor, Texas, 1997 Approved LPC Supervisor, Texas, 2002 With DCAC since 2000 Teach a master s level play therapy class 1

Goals of This Seminar Increase your familiarity with ethical codes Motivate you to know the ethical codes Present several ethical decision making models Stimulate open discussion and critical thinking about ethical issues especially related to child/ play therapy Motivate you to hold yourself to the highest possible ethical standards Try to have a little fun with a serious topic Ethics Defined According to Webster, an ethic is a system or philosophy of conduct and principles practiced by a person or group. Ethics are related to values, moral principles, and concepts of right and wrong. Ethics vs. Law The law defines minimum standards and is enforced by government with possible criminal prosecution. Ethics sets the highest standard or ideal we are to strive for in our conduct or practice. This is generally enforced by associations or licensing boards with civil penalties. 2

Why We Need Ethical Codes To protect the public To provide professionals with ethical principles to guide their practice To provide a means for professionals to hold each other accountable To provide clients a means to hold professionals accountable To encourage best practices Foundations of Ethics Six Pillars of Character Trustworthiness, Respect, Responsibility, Fairness, Caring, Citizenship Social Work Values Service, Social justice, Dignity of the person, Importance of human relationships, Integrity, Competence APA Principles Beneficence/Nonmaleficence, Integrity, Justice, Fidelity/Responsibility, Respect for people s rights/dignity The Codes American Counseling Association National a Association o of Social Workers American Psychological Association Association for Play Therapy Voluntary Practice Guidelines 3

What Not To Do Dual Relationships Breaching Confidentiality Incompetent Practice Dual Relationships Most of the codes are very clear about no sex with current clients or family members. Regarding former clients and family members: NASW says no ACA says no for 5 years after termination APT says no if it would be detrimental to client APA says no for 2 years after termination ACA, APT and APA also discourage other dual, multiple or non-professional relationships. 4

Breaching Confidentiality All the codes are in agreement that protecting clients confidentiality is crucial. All codes require professionals to take any and all reasonable steps to ensure confidentiality of clients information and records written & electronic. All the codes mandate informing clients of the limits of confidentiality at the outset of therapy. Limits of Confidentiality All codes outline similar limits of confidentiality. Imminent danger to self or others (suicidal/homicidal ideation, and suspected child abuse) Court ordered disclosure Preventing the spread of contagious diseases Incompetent Practice All the codes warn against practicing or using techniques outside your competence. All codes define competence by education, training, experience and credentials. All codes warn against misrepresenting your level of education, licensure and expertise. 5

What To Do Good informed consent Good records Good supervision/consultation Best practices Continuing Education Informed Consent Purposes & goals of treatment Limits of confidentiality Fees/payment information Risks and benefits of services Alternative treatments HIPPA/access to records Right to refuse services Testing and diagnosis Record Keeping Generally more detail is better in progress notes. Make sure to document checking psychosis, si/hi in cases of depression or with a history of any of these. Avoid judgments & interpretations in notes. Make sure to record any & all contacts with client/family. Make sure billing records are accurate. 6

Supervision/Consultation CONSULT, CONSULT, CONSULT!!! Consult your supervisor first Consult others at or above your level of training and experience Consult more than one person DOCUMENT, DOCUMENT, DOCUMENT!!! All consults Your decision making process The more information recorded the better Best Practices Be familiar with research in your area. Get supervision on new techniques/ approaches. Attend trainings before using new techniques/approaches. Avoid experimental techniques. Ethical Issues in Child Therapy Who is the real client? Confidentiality Diagnosis and treatment planning Kids artwork Gifts 7

Who Is the Real Client Legally and ethically a minor can t request services so the parent is the client. APT ethics say the child is the client and should be involved in informed consent, etc. Per state laws teens and sometimes children can consent for sex abuse and substance abuse treatment. Kids and Confidentiality APT says kids have a right to confidentiality and to have it explained to them. Parents have a right to know what s going on in their kids treatment. Small kids are easier. Older kids can be tricky. Diagnosis and Treatment Plans Children present differently so we should take extra care in diagnosis. Avoid the temptation to over diagnose for insurance purposes. Keep treatment plans behaviorally focused and consistent with diagnosis and symptoms. Update treatment plans frequently. 8

Kids Artwork To display or not to display Sometimes kids like to see their artwork displayed. Sometimes parents don t. Artwork is a product of therapy and can be deeply personal. Gifts ACA is the only code to specifically address gifts. Consider value of gift Consider client s motivation for giving Consider your own motivation for accepting or declining Consider impact on client of accepting or declining Ethical Issues Related to Abuse Reporting additional abuse Court Testimony Custody Issues Physical Contact 9

Reporting Additional Abuse All states have mandated reporting laws All codes address our obligation to report abuse Effect on families already in the system Effect on rapport with client Court Testimony Mention in informed consent Discuss in depth with child and parent if you are subpoenaed Don t surrender records or testify without a subpoena Have an attorney on retainer and fight if necessary Custody Issues Custody battles Counselor s role Dealing with lawyers Discuss with parent Consult your own lawyer 10

Physical Contact APA, ACA don t address this NASW discourages but doesn t prohibit APT allows touch but adds caveats Before any contact, consider: Whose need is this meeting? Will it benefit the child? Could it harm the child? Why Behave Ethically? Unity between principled belief and honorable behavior is the foundation for real happiness. Making Ethical Decisions booklet from the Josephson Institute Ethical Decision Making Models Common Themes Consult Consult Consult! Document Document Document! Differences Emphasis on scholarship and deliberation before hand vs. emphasis on reflection and analysis of outcome/results 11

Josephson Model 1. Stop & Think 2. Clarify Goals 3. Determine Facts 4. Develop Options 5. Consider Consequences 6. Choose an Action 7. Monitor & Modify Forester-Miller & Davis Model 1. Identify the problem. 2. Apply the ACA (or your field s) ethical code. 3. Determine the nature of the dilemma. 4. Generate possible courses of action. 5. Consider potential consequences and choose a course of action. 6. Evaluate the selected course of action. 7. Implement the course of action. The Pocket Ethicator 1. Identify the ethical dilemma then state it 2. Brainstorm options 3. Review ethical codes, applicable laws and literature 4. Consider the (foundational) ethical principles i 5. Consult colleagues 6. Evaluate options 7. Make a decision 8. Develop a plan 9. Implement the plan 10. Reflect on the process Copyright by Barry Zabielinski 12

Ethical Dilemma 13 year old Suzie comes to you for therapy and discloses that she uses marijuana. With some prompting she admits she uses pretty regularly and has tried a few other drugs. She asks you not to tell her parents. Ethical Dilemma 14 year old Johnny comes to you for therapy and eventually discloses that he uses marijuana occasionally. After further discussion, you believe he really is just using occasionally and has not tried other drugs. He has a physically absent father and an emotionally absent mother. He asks you not to tell his mother. Ethical Dilemma You have been seeing 5 year old Mary for a few months. She was referred for probable sexual abuse by her father but has not made a clear outcry so police can t fl file charges. You believe Mary was abused based on some statements she has made and on her behavior in the playroom. The mother is now seeking to terminate the father s parental rights and her lawyer has called you asking you to testify for her. 13

Why Behave Ethically? True happiness in not attained through self-gratification, But through fidelity to a worthy purpose. - Helen Keller Bibliography ACA Ethical Standards Casebook, 6 th Ed., 2006 by Herlihy & Corey Ethical, Legal and Professional Issues in Counseling, Updated 2006 by Remley & Herlihy Making Ethical Decisions (Booklet) available at www.josephsoninstitute.org/med A Practitioners Guide to Ethical Decision Making, 1996 by Forester-Miller & Davis available at www.counseling.org/resources Want to Contact Me? Wynne Shaw Dallas Children's Advocacy Center 214-818-2655 WShaw@DCAC.org 14