CBT-I Ethical Standards & Professional Practice 2 — Questions and Answers
Question 1: A CBT-I practitioner discovers that a client is also receiving sleep coaching from an unlicensed online service. What is the most ethically appropriate first step?
- Immediately terminate the therapeutic relationship
- Discuss the concurrent services openly with the client and assess potential conflicts (Correct answer)
- Report the unlicensed coach to licensing authorities
- Continue treatment without addressing the issue
Correct answer: Discuss the concurrent services openly with the client and assess potential conflicts
Ethical practice requires transparent communication with clients about concurrent services to avoid conflicting advice and protect client welfare.
Question 2: When a CBT-I client discloses that their insomnia is partly due to caring for a terminally ill spouse, the practitioner should:
- Focus exclusively on sleep hygiene and restrict discussion to CBT-I protocols
- Acknowledge the grief context and consider referral for bereavement support alongside CBT-I (Correct answer)
- Defer all CBT-I treatment until the caregiving situation resolves
- Diagnose the client with complicated grief disorder
Correct answer: Acknowledge the grief context and consider referral for bereavement support alongside CBT-I
Competent ethical practice involves recognizing comorbid psychosocial stressors and facilitating appropriate adjunct referrals while continuing evidence-based sleep treatment.
Question 3: Which action best reflects the ethical principle of fidelity in CBT-I practice?
- Charging consistent fees regardless of session length
- Honoring commitments made to clients about treatment structure and follow-up (Correct answer)
- Maintaining accurate billing records
- Providing equal treatment to all demographic groups
Correct answer: Honoring commitments made to clients about treatment structure and follow-up
Fidelity refers to trustworthiness and keeping promises, such as adhering to agreed-upon session schedules and treatment plans.
Question 4: A CBT-I practitioner is asked by a client's employer to confirm whether the client is receiving treatment for work-performance-related insomnia. The practitioner should:
- Confirm treatment is occurring but withhold the diagnosis
- Refuse to disclose any information without specific written authorization from the client (Correct answer)
- Provide a general letter stating the client is in good health
- Contact the employer directly to negotiate what can be shared
Correct answer: Refuse to disclose any information without specific written authorization from the client
Confidentiality requires that no information be disclosed to third parties, including employers, without explicit written informed consent from the client.
Question 5: A practitioner realizes mid-treatment that the client's insomnia may stem from undiagnosed sleep apnea. The ethical obligation is to:
- Continue CBT-I as planned since it is evidence-based regardless of etiology
- Refer the client for a sleep study and adjust the treatment plan accordingly (Correct answer)
- Diagnose sleep apnea within the CBT-I scope of practice
- Discontinue treatment immediately and end the therapeutic relationship
Correct answer: Refer the client for a sleep study and adjust the treatment plan accordingly
Competence and client welfare require recognizing the limits of CBT-I and facilitating medical evaluation when an underlying physiological condition is suspected.
Question 6: Which scenario represents a boundary violation rather than a boundary crossing in CBT-I practice?
- Briefly extending a session by five minutes to complete a sleep diary review
- Accepting a modest gift of homemade cookies at the end of treatment
- Entering into a business partnership with a current client (Correct answer)
- Providing a client with an after-hours crisis number
Correct answer: Entering into a business partnership with a current client
A business partnership with a current client constitutes a dual relationship that compromises objectivity and exploits the power differential, making it a boundary violation.
Question 7: Under HIPAA, a CBT-I practitioner in a group practice must ensure that:
- All staff members have unrestricted access to client records for continuity of care
- Client protected health information is accessible only on a minimum necessary basis (Correct answer)
- Paper sleep diaries are stored in the client's personal file without additional protection
- Electronic records are encrypted only when transmitted outside the practice
Correct answer: Client protected health information is accessible only on a minimum necessary basis
The HIPAA minimum necessary standard requires that access to protected health information be limited to what is needed to perform a specific function.
CBT-I Ethical Standards & Professional Practice 2
A CBT-I practitioner discovers that a client is also receiving sleep coaching from an unlicensed online service.
What is the most ethically appropriate first step?