Moral Sensitivity
recognition that our actions affect the welfare of others
Murphy, chapter 1
4 criteria of ethical decision making
- Ethical compenents
- clinical components
- potential legal issues
- potential professional issues
Murphy, chapter 1
Therapist-patient sex syndrome
syndrome that often results following client-therapist sexual relationship. Symptoms for client often similar to those who are victims of incest and rape and include: lower self-esteem, ambivalence, guilt, emptiness, isolation, sexual confusion, difficulty trusting others, identity and boundary confusion, cognitive dysfunction, supressed rage, suicidality
Sanders, chapter 5
malpractice
when client feels therapist acted recklessly, negligently, or intenionally injured another.
Examples: misdiagnosis, practicing outside scope of practice, failure to obtain informed consent, failure to refer to another professional, sexual contact, nonsexual physical contact, failure to prevent client from harming themselves or others, failure to supervise
Murphy, chapter 3
Clients moderate risk of being victims sexual abuse from therapist
- personality disorder
- history of relationship problems
- need/dependent
Sanders, chapter 5
Clients high risk of being victims of sexual abuse from therapist
- incest survivors
- borderline personality disorder
Sanders, chapter 5
types of therapist abuse of power
- harassement
- discrimination
- exploitation
- deception
- manipulation
Sanders, Chapter 5
4 types of sexually abusing therapists
- Psychotic disorder (e.g. have schizophrenia or bipolar)
- predatory psychopathology & paraphilias (antisocial and narcissistic personality disorders)
- lovesickness (claim to be in love, have strong need to be in loved and idealized by the client, believe relationship special and warrants breaking ethical code)
- masochistic surrender (allow self to be intimidated and controlled by client, succumbs to sexual demands out of guilt)
Sanders, chapter 5
Warning signs of boundary crossing that may lead to sexual abuse by the therapist
- strategically schedule client to give them more time
- excessive telephone calls with client
- longer sessions
- laxity with fees
- excessive self-disclosure
- meetings arranged outside of the office
- exchanging gifts
- making exceptions for the client and/or viewing them as “special”
- asking client to do work at the therapist’s home or office
- lack of self-care/unmanaged stress
- stressful events in the therapist’s life
- dennial of attraction to client and any boundary issues
Murphy, chapter 7 and Sanders, Chapter 5
How to respond to client’s sexual advances or harassment
- set limits with client - affirm boundaries of what you will and will not do
- don’t be cold and rejecting and attacking toward client when setting the boundary
- continue to express non-sexual caring and nurture to the client
- do not be drawn into answering personal questions
- don’t blame the external rules of ethics alone - implies that if the rules were not in place you would act differently
- don’t automatically refer out, only if the client continues to violate the boundary once re-affirmed and you have sought consultation
Murphy, chapter 7
3 types of safeguards for electronic PHI
- administrative (e.g. policies and procedures that define who has access, password management, software protection, contingency plans, emergency plans, etc.)
- physical (e.g. protect PHI from natural or environmental hazards, such as floods or tornadoes, and from human intrusion i.e. hackers)
- technical (e.g. policies and procedures around unique passwords, automatic log-outs, encryption, audit controls, etc. so only authorized personel have access)
Murphy, chapter 4
