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Ethics and Legal Issues in Counseling

Based on the case below:

-what are the ethical and legal issues in this case?
-specific ethical standards and state laws that would apply here
-Are there cases where a therapist might also be justified in omitting or minimizing the diagnosis that is placed in a client's records or submitted to third-party payers? Support your position with references.

Alice case study:

Alice is a therapist who has been licensed for one year and is just starting to build up her private practice. She sees several clients referred to her from the local college where she completed her fieldwork hours and she also works with clients who are contemplating job changes or dealing with basic life transitions.

Some of the clients Alice sees have clear goals for their work in counseling, but they don't have symptoms that are significant enough to meet the DSM IV-TR diagnostic criteria required for receiving reimbursement from their insurance companies. The clients say they really need help paying for their counseling and may not be able to come regularly to sessions if they cannot get reimbursement. In these cases, Alice adds a DSM IV-TR diagnosis such as "Generalized Anxiety Disorder" or "Adjustment Disorder with Depression" to the clients' claim forms so their insurance companies will pay for sessions and the clients will only have to come up with the co-payment.

Alice believes that insurance companies should support all forms of mental health treatment and states that many of these clients would probably develop more serious issues if they were not able to come to their sessions.

Solution Preview

Ethics and Diagnosis

(1) Based on the case below, what are the ethical and legal issues in this case?

Beresoff (2003) in citing American Psychological Association's APA, 2002) ethical standards notes, "Inadequate coverage for clients with urgent needs [creates] a cruel ethical dilemma in which therapists felt forced either to breach their responsibilities to clients, or to be less than honest with... [an] adversarial provider of reimbursement" (p. 9). As Gabbard (2000) points out, therapists, while recognizing that some providers are reluctant to cover psychotherapy costs for Personality Disorders (PD), they argue that patients with PO's respond to therapy. According to Beresoff, the APA (1990, 1991), addressed ethical principles both in terms of the relationship of financial management to a patient's best interests, and prolonged therapist-client relationships beyond benefits to the client; however, guidelines do not directly address third-party payments. On this basis, third-party payers such as Health Maintenance Organizations (HMO's) and Employee Assistance Plans (EAP's) have called for more direct guidelines to address the ethical dilemma created by the tension between professionals' needs to effectively treat their clients, and payment providers (Beresoff, 2003).

(2) Specific ethical standards and state laws that would apply here.

Many states have provisions in their mental health confidential laws that permit disclosures, which ...

Solution Summary

This solution addresses specific legal and ethical issues related to a case study.