CBT Professional Ethics and Multicultural Competence 3 — Questions and Answers
Question 1: Under HIPAA, a therapist may share protected health information with another treating provider:
- Only with written client authorization in all circumstances
- For treatment purposes without explicit client authorization, though notification is best practice (Correct answer)
- Only if the client is currently hospitalized
- Only after the therapy relationship has ended
Correct answer: For treatment purposes without explicit client authorization, though notification is best practice
HIPAA's treatment exception allows providers to share protected health information for treatment coordination without explicit written authorization, though many practitioners notify clients as a matter of good practice.
Question 2: A White therapist working with a Black client experiences uncertainty about whether to address a racial microaggression the client reported receiving at work. The most competent ethical action is to:
- Avoid the topic to prevent discomfort in the therapeutic relationship
- Follow the client's lead, validate the experience, and address it if clinically relevant to treatment goals (Correct answer)
- Suggest the client may have misinterpreted the colleague's intent
- Refer the client to a therapist of the same racial background
Correct answer: Follow the client's lead, validate the experience, and address it if clinically relevant to treatment goals
Multicultural competence requires the therapist to validate racial experiences and address them when clinically relevant, rather than avoiding potentially uncomfortable topics.
Question 3: The ethical concept of 'fidelity' in therapy refers to:
- Maintaining accurate clinical records
- Honoring commitments, keeping promises, and being trustworthy in the therapeutic relationship (Correct answer)
- Using evidence-based treatments exclusively
- Advocating for clients' rights in legal proceedings
Correct answer: Honoring commitments, keeping promises, and being trustworthy in the therapeutic relationship
Fidelity is the ethical principle of being faithful and trustworthy, which includes honoring commitments made to clients within the therapeutic relationship.
Question 4: A CBT therapist who holds conservative religious values is asked to treat an LGBTQ+ client seeking help with relationship issues. The therapist should:
- Refer the client elsewhere immediately to avoid value conflicts
- Provide competent, affirming care or refer to a therapist who can, ensuring the client is not abandoned (Correct answer)
- Disclose personal religious beliefs to the client during the first session
- Treat the client's sexual orientation as a target for change
Correct answer: Provide competent, affirming care or refer to a therapist who can, ensuring the client is not abandoned
Ethical practice requires affirming care for LGBTQ+ clients; if the therapist cannot provide this, they must refer competently to avoid client abandonment, and must never engage in conversion practices.
Question 5: Which scenario most clearly represents a violation of informed consent in CBT?
- Using a standard consent form that describes common CBT techniques
- Beginning exposure exercises without explaining the rationale, expected discomfort, or client's right to decline (Correct answer)
- Discussing the limits of confidentiality during the first session
- Providing psychoeducation about the cognitive model before starting treatment
Correct answer: Beginning exposure exercises without explaining the rationale, expected discomfort, or client's right to decline
Informed consent requires that clients understand what they are agreeing to, including the nature, purpose, potential discomfort, and their right to refuse any intervention.
Question 6: A therapist's client reveals that they have been hiding marital problems from their spouse, and asks the therapist not to disclose this to anyone. The therapist should:
- Contact the spouse to ensure they are aware of the relationship difficulties
- Honor the client's confidentiality, as this is not a Tarasoff-type threat situation (Correct answer)
- Recommend couples therapy and refuse to continue individual sessions
- Document the disclosure and inform the insurance company
Correct answer: Honor the client's confidentiality, as this is not a Tarasoff-type threat situation
Confidentiality protects information disclosed in individual therapy; marital secrets are not grounds for breach unless there is a duty-to-warn situation involving harm to an identifiable party.
Question 7: Cultural humility, as distinct from cultural competence, emphasizes:
- Mastering a fixed body of knowledge about specific ethnic groups
- An ongoing process of self-reflection, openness to learning from clients, and recognizing power imbalances (Correct answer)
- Matching therapists and clients by ethnicity whenever possible
- Completing a single multicultural training course before practicing
Correct answer: An ongoing process of self-reflection, openness to learning from clients, and recognizing power imbalances
Cultural humility is a lifelong process of self-examination and openness, acknowledging that no therapist can fully 'master' another's culture and emphasizing respectful curiosity over assumed expertise.
CBT Professional Ethics and Multicultural Competence 3
Under HIPAA, a therapist may share protected health information with another treating provider: