1. Questions
Which standard in therapy has the most impact on you and why?
What do you as a professional need to do to make sure that you are always following the standard as outlined?

2. “You make the Call”
A therapist chooses to set up a play date between his kids and his client’s kids
The therapist agrees to see the client’s mother in individual therapy too
Therapist agrees to a social outing with a former client

3. Unclear Scenarios that could lead to dual relationships
A pastor with a degree in marriage and family counseling meets with one of his church members for private counseling. The church member tells the pastor of several conflicts going on in her family.
The pastor is also a friend of the church member’s family and he and his wife are often invited over for dinner.
Pros/Cons of this dual relationship?

4. When to Avoid Dual Relationship?
American Psychological Association (APA) definition:
A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists. APA Ethics Code

5. Summary of Professional Association Guidelines
Therapists should avoid dual relationships whenever possible
if they may harm the client
(and the profession)
Too simple?

6. Dual Relationships and Rural Practice
Avoiding dual relationships is harder for clinicians in rural settings.
Even if the clinician doesn’t know a client personally, he or she may know others who know the client and may have knowledge about the client from those other people

7. Types of Dual Relationships
The primary connection is usually the therapy relationship, with a separate established relationship occurring outside of therapy
Three possible separate connections can occur:
1) Pre-existing relationship
2) close association
3) future relationship
(Koocher & Kieth-Spiegel, 2008, Ethics in Psychology and the Mental Health Professions)

8. Pre-Existing Relationship
The therapist and client already share another role
Examples:
The therapist and client are business partners or colleagues
The therapist and client are members of the same church

9. Close Association
The therapist is closely connected with someone associated with or related to the client
Examples:
The client is the daughter of the therapist’s friend.
The client is the personal assistant of the therapist’s father.

10. Future Association
The therapist promises to enter into another role with the client or with a person closely associated with or related to the client in the future
Examples:
The therapist and client agree to work on the same community committee after therapy ends.
The therapist agrees to help the client’s parents with their taxes. (Koocher et al., 2008)

11. Dual Relationships can be Chosen or Unexpected
Dual Relationships can occur by chance or by choice
Those that occur by choice should often be avoided
E.g. Declining to treat neighbor’s child
However, often dual relationships can occur unexpectedly, after therapy has begun. (Moleski, S. & Kiselica, M., 2005)

12. Examples of Dual Relationships that Occur Unexpectedly
In a small town the child of the therapist may turn out to be in the same class at school as the child of the client
The therapist may run into the client while waiting at the doctor’s office
Client may appear at a party you are attending (Moleski, S. & Kiselica, M., 2005)
Examples?

13. Ethics and Standards of Professional Psychology
Kevin Wickes
Unit 6 Seminar
(Fees, Maintenance, and APA Ethics)

14. Overview
Clinical fees for service and bartering of fees for services are common practices in some areas of the country. Using the standards in the Code, what requirements must a psychology professional follow in these areas? What can happen under the Code when there is misrepresentation or withholding of records pertaining to fees? What is your view on bartering for services? Do you agree or disagree with the Code?
With changes in the economy, many times a client has to pay up front for the services provided by a psychology professional. Some professionals will lower their fees if a client pays in cash for each scheduled appointment. What type of ethical issues can this professional face if this is reported to the APA? How would you handle working for a psychologist who did this?

15. Bartering - This is the act of trading goods or services, rather than money, for provision of counseling services. Bartering is strongly discouraged as a method of payment for counseling services rendered.
Definition

16. Bartering for Professional Services
Bartering involves exchanging services in lieu of paying a fee.
Such bartering can often lead to hurt feelings due to one party feeling that the exchange was or is inequitable.

17. Ethical Standards on Bartering
Bartering should be evaluated within a cultural context.
Thomas (2002) maintains that bartering should not be ruled out simply because of the slight chance that a client might initiate a lawsuit against the therapist.
Thomas recommends a written contract that spells out the nature of the agreement between the therapist and client, which should be reviewed regularly.

18. Standard 6: Record Keeping and Fees
6.04: Fees and Financial Arrangements
Reach an agreement ASAP about fees and billing
Fees should be 1) correctly represented, 2) legal
If they cannot pay, you need to discuss with the client any plans and steps to be taken
6.05: Barter with Clients / Patients
Can only do it if it is not clinically contraindicated and nonexploitative
6.06: Accuracy in Reports to Payors and Funding Sources
Accurate nature of services and fees
When applicable, provide diagnosis and service provider
6.07: Referrals and Fees
Payment based on services provided and not on the referral itself

19. Bartering and Dual Relationships
“Psychologists may barter only if
(1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative” (APA, 2002)

20. Bartering and Dual Relationships
Bartering could lead to a dual relationship
Could lead to meeting client outside of professional office
Could lead to vagueness in the payment schedule, sense of special treatment
Bartering likely pushes boundaries of professional relationship

21. Bartering Scenario
A client of 14 sessions advises that she has lost her insurance and can not continue. She asks if therapist is willing to exchange childcare for therapy.
1) Could this be an ethical agreement in the eyes of professional peers?
2) What if the offer was dry-cleaning at her family business, or bulk meat from her butcher business?

22. Bartering: Guidelines for Practice
Will barter put you at risk for impaired professional judgment, or negatively impact therapy?
Better to exchange goods than services
Determine value of goods or services in collaborative fashion
Determine appropriate length of time for barter
Document arrangement, including value of goods, end date, and have client sign
If misunderstanding develops, use mediator

23. Deciding About Bartering…
Bartering is not prohibited by ethics or law, but most legal experts frown on the practice.
If you decide to barter with a client, you would need to report the bartered services or goods as income to the Internal Revenue Service.
Create a written contract that specifies hours spent by each party and all particulars of the agreement.

24. Section D: Relationship With Other Professionals
SP-29 Accepting Fees from Agency Clients - Counselors must not accept fees or other remuneration for consultation with persons entitled to such services through the counselor's employing agency or institution.
SP-30 Referral Fees - Counselors must not accept referral fees.

25. Summation
Walk with Caution…