OLERE Client Welfare and Informed Consent 2 — Questions and Answers
Question 1: When a minor client's parents disagree about whether the child should continue counseling, the counselor's primary obligation is to:
- Side with the parent who has legal custody
- Focus on the child's best interests while respecting legal custody arrangements (Correct answer)
- Continue counseling only with both parents' consent
- Terminate services immediately to avoid a conflict
Correct answer: Focus on the child's best interests while respecting legal custody arrangements
The counselor's primary ethical obligation is to the client's welfare. When parental disagreements occur, the counselor should focus on the child's best interests while navigating legal custody arrangements.
When parents disagree about a minor child's counseling, the counselor must consider both the legal context of who has custody authority and the child's best interests. If one parent has sole legal custody, that parent typically has authority to make decisions about counseling. The counselor should document all decisions carefully. Legal consultation may be needed in contentious situations.
Question 2: A client's employer requests information about the client's diagnosis and treatment progress. Without a specific release signed by the client, the counselor should:
- Share general treatment information but not the specific diagnosis
- Decline to confirm or deny that the individual is a client (Correct answer)
- Share information because employers have a legitimate need to know
- Provide information to protect the employment relationship
Correct answer: Decline to confirm or deny that the individual is a client
Without a valid release of information signed by the client, the counselor cannot share any information including whether the person is even a client. The counselor should decline to confirm or deny the therapeutic relationship.
HIPAA and Oklahoma's confidentiality laws protect all client information, including whether a person is receiving services. Without a valid specific written release of information, the counselor must decline the employer's request entirely, not even confirming the individual is a client. Employers generally do not have an inherent right to mental health information.
Question 3: A counselor is using a new evidence-based treatment approach with a client. The ethical obligation of informed consent requires the counselor to:
- Use the technique without disclosure to avoid client resistance
- Explain the technique, its benefits, limitations, and any alternatives (Correct answer)
- Obtain consent only if the technique involves physical contact
- Get supervisor approval before explaining the approach to the client
Correct answer: Explain the technique, its benefits, limitations, and any alternatives
Informed consent for treatment includes explaining the nature of proposed techniques, their theoretical basis, benefits, potential risks, and alternatives, allowing clients to make informed decisions about their own care.
Informed consent for specific treatment techniques is an ongoing process in counseling. When introducing a new or specialized approach, the counselor should explain what the technique involves, the theoretical rationale, evidence base, potential benefits and risks, and any available alternatives. This allows the client to give meaningful consent. This is especially important for techniques that may be emotionally intense, such as EMDR or exposure therapy.
Question 4: A counselor becomes romantically attracted to a current client. The ethical and legal response is to:
- Pursue the relationship because attraction is natural and uncontrollable
- Seek consultation and supervision to manage the feelings and refer if necessary (Correct answer)
- Terminate the counseling relationship immediately and begin a romantic relationship
- Disclose the attraction to the client to maintain transparency
Correct answer: Seek consultation and supervision to manage the feelings and refer if necessary
When a counselor experiences attraction to a client, the ethical response is to seek consultation and supervision to manage the feelings professionally. If the feelings cannot be managed without affecting care, referral may be necessary.
Counselors are human and may experience attraction to clients. The ethical obligation is to manage these feelings professionally through consultation and supervision. The counselor must never act on the attraction or terminate services abruptly just to pursue a romantic relationship. If the feelings interfere with providing competent care, the counselor should transfer the client to another provider. Sexual or romantic relationships with current clients are absolutely prohibited.
Question 5: Under the concept of therapeutic privilege in Oklahoma counseling practice, a counselor may withhold information from a client when:
- The counselor believes the information will upset the client
- Disclosure would cause serious harm to the client or others (Correct answer)
- The client has demonstrated limited cognitive capacity
- The counselor believes the client will not understand the information
Correct answer: Disclosure would cause serious harm to the client or others
Therapeutic privilege, withholding information to protect the client, is a very narrow exception. It applies only when disclosure itself would cause serious harm, not merely because the information is upsetting or difficult to understand.
The concept of therapeutic privilege allows providers to withhold information in very limited circumstances where disclosure itself would cause immediate serious harm. Simply believing information will be upsetting or that the client may not understand it does not justify withholding it. Informed consent is fundamental to client autonomy, and therapeutic privilege must be applied narrowly with careful documentation.
Question 6: A client requests a copy of their counseling records. Under Oklahoma law and professional ethics, the counselor should:
- Provide records only to the client's attorney, not directly to the client
- Provide the records within a reasonable time and may charge a reasonable fee (Correct answer)
- Refuse because providing records could harm the therapeutic relationship
- Provide only a summary of the records, not the full documentation
Correct answer: Provide the records within a reasonable time and may charge a reasonable fee
Under HIPAA and Oklahoma law, clients have the right to access their own mental health records. The counselor must provide records within a reasonable timeframe and may charge a reasonable cost-based fee for copying.
HIPAA's Privacy Rule grants clients the right to access their protected health information. Counselors must respond to records requests within 30 days and may charge a reasonable, cost-based fee. They cannot routinely deny access to clients. However, there are narrow exceptions when access would endanger the client or another person. Such denials require documentation and the client must be informed of their right to appeal.
OLERE Client Welfare and Informed Consent 2
When a minor client's parents disagree about whether the child should continue counseling, the counselor's primary obligation is to: