CBT Professional Ethics and Multicultural Competence 2 — Questions and Answers
Question 1: A CBT therapist working with a Latino client notices that the client frequently defers to the therapist's opinions and avoids disagreeing. The most culturally competent response is to:
- Interpret the deference as resistance to therapy
- Recognize that familismo and respeto may influence how the client engages with authority figures (Correct answer)
- Encourage the client to adopt a more assertive communication style immediately
- Document the behavior as a personality trait in the clinical record
Correct answer: Recognize that familismo and respeto may influence how the client engages with authority figures
Understanding cultural values like respeto (respect for authority) and familismo helps therapists interpret client behavior through a culturally informed lens rather than pathologizing it.
Question 2: When a supervisee discloses that they have a romantic interest in a current client, the ethical supervisor should FIRST:
- Report the supervisee to the licensing board immediately
- Explore the supervisee's feelings in a supportive, non-shaming manner and clarify the ethical prohibition (Correct answer)
- Transfer the client to another therapist without explanation
- Document the disclosure and take no further action
Correct answer: Explore the supervisee's feelings in a supportive, non-shaming manner and clarify the ethical prohibition
The supervisor's first step is to address the issue educationally and supportively, clarifying that sexual or romantic relationships with clients are ethically prohibited.
Question 3: A CBT therapist receives a subpoena for a client's therapy records. The therapist should:
- Immediately release all records to comply with the legal order
- Consult with an attorney and notify the client before releasing records, unless legally prohibited (Correct answer)
- Refuse to release any records citing therapeutic privilege
- Release only the intake form and no progress notes
Correct answer: Consult with an attorney and notify the client before releasing records, unless legally prohibited
Receiving a subpoena does not automatically waive confidentiality; the therapist should consult legal counsel and inform the client, as a subpoena differs from a court order.
Question 4: Which of the following best illustrates the ethical principle of nonmaleficence in CBT practice?
- Providing psychoeducation about the CBT model
- Avoiding the use of exposure techniques with a client who has unmanaged cardiac conditions without medical clearance (Correct answer)
- Offering sliding-scale fees to low-income clients
- Obtaining informed consent before beginning treatment
Correct answer: Avoiding the use of exposure techniques with a client who has unmanaged cardiac conditions without medical clearance
Nonmaleficence means 'do no harm'; avoiding potentially dangerous interventions without appropriate medical clearance exemplifies this principle.
Question 5: A therapist practicing from a multicultural competence framework understands that acculturation stress in immigrant clients:
- Should be reframed as cognitive distortions and challenged directly
- Can manifest as anxiety and depression symptoms and should be contextualized within the client's migration experience (Correct answer)
- Is best treated by encouraging full assimilation into the dominant culture
- Is not within the scope of CBT treatment
Correct answer: Can manifest as anxiety and depression symptoms and should be contextualized within the client's migration experience
Acculturation stress is a recognized psychosocial stressor, and culturally competent CBT contextualizes symptoms within the client's migration and cultural adaptation experience.
Question 6: An Asian American client tells the therapist she feels shame about experiencing depression because mental illness is stigmatized in her family. The most culturally responsive CBT approach would be to:
- Immediately challenge the shame as irrational
- Explore the cultural meaning of shame and stigma while collaboratively adapting psychoeducation to reduce self-blame (Correct answer)
- Avoid discussing cultural factors to keep therapy focused on cognitions
- Refer the client to a therapist from the same ethnic background
Correct answer: Explore the cultural meaning of shame and stigma while collaboratively adapting psychoeducation to reduce self-blame
Culturally responsive CBT acknowledges the role of shame and stigma within cultural contexts and adapts interventions collaboratively rather than dismissing cultural experiences.
Question 7: A therapist realizes they have inadvertently created a dual relationship by joining the same religious congregation as a current client. The ethical course of action is to:
- Immediately terminate therapy to avoid further boundary complications
- Consult with a supervisor or ethics board, discuss the situation transparently with the client, and document the steps taken (Correct answer)
- Ignore the overlap because religious settings are outside the therapeutic relationship
- Ask the client to switch to a different religious community
Correct answer: Consult with a supervisor or ethics board, discuss the situation transparently with the client, and document the steps taken
When an inadvertent dual relationship occurs, ethical practice requires consultation, transparent discussion with the client, and careful documentation of risk management steps.
CBT Professional Ethics and Multicultural Competence 2
A CBT therapist working with a Latino client notices that the client frequently defers to the therapist's opinions and avoids disagreeing.
The most culturally competent response is to: