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Legal Standards for Professional Practice
CA MFT Law and Ethics Exam
32
Psychology
Post-Graduate
03/26/2017

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Term
14-year-old Athena and her mother, Voula, moved here from Greece one year ago and were referred by Athena's school counselor. Athena has been cutting school and her grades have been dropping. Tearfully, Voula says, "I don't know what I've done wrong. I just want to sleep all the time." Voula asks, "Can I pay for therapy when I get a job?" How would you clinically manage the legal issue of fees?
Definition
Reach an agreed-upon fee arrangement prior to the commencement of therapy.

This would be a legal obligation.
Term
As part of his telehealth practice, a therapist offers quick assessment surveys online to help potential clients decide if they want therapy. The surveys do not ask for any identifying information. The therapist has access to the results of the surveys but does not ask for the name of the consumer, to avoid the appearance of solicitation. This is legal if:
Definition
The surveys are offered at no cost, or fees for completing the surveys are disclosed before the client begins the survey.
CORRECT.

If any fees are associated with clinical practice, therapists are legally obligated to disclose them before providing a service.
Term
Guidelines regarding advertising state that therapists must advertise in a way that is honest and not misleading. Which of the following is a true statement regarding advertising policies?
Definition
The advertisement must indicate the full name of the licensee and the license number.

It is a legal requirement to include the license number of the MFT or the registration number of an MFT intern.
Term
John is a client whom you referred to a psychiatrist for an evaluation. He was reluctant to go because he has a history of steroid abuse that he does not like to talk about. He was given a prescription for SSRIs to alleviate his depression that he has been taking for six months. John comes to session this week and tells you that he has stopped taking the medication. You would:
Definition
Refer John back to the prescribing psychiatrist.

Referring John back to the psychiatrist would be the most appropriate action, as the psychiatrist could explain the benefits of taking the medication and the repercussions of abruptly terminating it.
Term
Your client missed a regularly scheduled appointment. Your policy, made clear to the client in your informed consent document, is that clients will be billed for missed appointments. The client asks you to bill the insurance company. What would you do?
Definition
Bill the insurer, indicating that the charge is for a missed session, and tell the client he/she is ultimately responsible for the fee.

It is legal to bill insurers for missed sessions, as long as this is clearly indicated in the billing codes.
Term
A woman brings in her 73-year-old father who has just been to a doctor. He is complaining of stomach pains. He doesn't know where he is, is disorganized and dizzy. What would you do first?
Definition
Refer him for a psychiatric evaluation.

A referral to a psychiatrist is the best choice, as a psychiatrist is a medical doctor who can evaluate the possibility of organic deficiencies, which is out of the MFT scope of practice.
Term
A client that you treated 3 years ago terminated when her therapy goals had been reached and she was ready. Which of the following would be legally required if this client returned to therapy with you at a new office?
Definition
Tell her if you have raised your fees.

You must disclose your fee before beginning therapy with a new or returning client.
Term
Your client has two children and is divorced. She tells you that when she arrived at her ex-husband's house last night to pick up the children, he had locked the doors and texted her that, "Me and my children are moving across the country." He has no criminal history but she is afraid she will never see her children again. Which of the following is the therapist's first intervention?
Definition
Advise her to call her lawyer.

Your only obligation in this situation is to maintain confidentiality and assess for a possibility of a crisis intervention. If the client is not afraid that the father will harm the children, she needs to call her lawyer to pursue legal options.
Term
Mrs. Moran is referred to you by a former client. On the phone she refers to you as "Doctor", although you do not possess this degree or license. It is apparent to you that Mrs. Moran is quite depressed. How would you handle this situation?
Definition
Inform Mrs. Moran of your license and qualifications.

Legal standards require therapists to correct inaccurate representations of their licensing status and professional qualifications. There is no reason not to inform Mrs. Moran of your licensing status simply because she is "quite depressed".
Term
Which of the following techniques would be considered out of a mental health professional's scope of practice if they did not receive the needed specialized training?
Definition
Hypnotherapy

Hypnotherapy needs specific, additional training beyond the education required to obtain a mental health professional license.
Term
A couple is in sex therapy. The sex therapy has focused on differences in their sexual desires. As they begin to make progress, one of the partners asks if they can come every other week, and if they do, if can they pay a lower fee. What is your legal obligation?
Definition
Document a new fee arrangement in your files.

Legally, the obligation would be to document any financial arrangement.
Term
After being in weekly therapy for 9 months, the client asks if she and the therapist can use telehealth to have sessions on an as-needed basis. If the therapist determines that this is clinically appropriate, what does the therapist need to do to make sure that online sessions are legal?
Definition
Disclose any fees which are different from in-person sessions.

Fee disclosures are legally required before changes to treatment occur.
Term
You have seen Abby, age 24, four times. In her fifth session, she discloses to you that her previous therapist fondled her while he was conducting hypnosis with her. Your legal obligation is to:
Definition
Give Abby a copy of the booklet "Professional Therapy Never Includes Sex" and discuss the contents with her.

You are legally obligated to give a client, who reports having had sexual contact with a previous therapist, the booklet, "Professional Therapy Never Includes Sex," as well as discuss the contents of the booklet with her.
Term
Which of the following is true regarding the Mental Health Parity Law?
Definition
If medical coverage includes inpatient and outpatient benefits, mental health care must also include inpatient and outpatient benefits.

The Mental Health Parity law requires that insurance companies provide equivalent coverage for medical benefits as for mental health care benefits if that company provides mental health benefits.
Term
George takes care of his wife Gracie because she is unable to work. George asks you to help him manage his finances so that he is able to pay Gracie's medical bills, the family bills, and afford therapy. How should you respond to George's request and still maintain proper therapeutic boundaries?
Definition
Inform George that he will still need to pay you for therapy, but that you are willing to adjust your fee if necessary.

Giving clients information about payment is a professional conduct issue.
Term
A therapist who performs telehealth advertises that the main advantage of internet therapy is that the client can reach a therapist in real-time: "If crises come up, or just a quick question, online therapy can meet your needs right away." This advertising is:
Definition
Legal if the therapist's informed consent information includes emergency contacts in the case that the therapist is unavailable.

Information about availability between sessions or in emergencies is an element of safety planning, which is both a legal and ethical requirement.
Term
You, a therapist, and the attorney in your office building agree to work together and make referrals back and forth. You each commit to making three referrals monthly and that the person making the most referrals that actually turn into paying clients over the next three months will "win" a weekend for two in Las Vegas. This arrangement is all of the following EXCEPT:
Definition
A bit unusual perhaps, but not unethical since the "prize" is not expensive and no one is really paying for referrals.

Whether or not the "prize" is expensive is not the point. Therapists do not pay for referrals or win prizes for making a lot of them. It is unethical and illegal.
Term
The Musso family is in treatment with you because they say they realize that they just don't know how to get along. Every time there is a discussion, about almost any problem, it ends up in a big argument and they want you to teach them how to communicate better. After explaining a family systems model for communication skills, the therapist would legally need to:
Definition
Make notes of the family's progress with specific communication interventions

Documenting the client's progress is a legal element which meets the standard of care.
Term
You were working with Arlen for six months when he lost his job working with an internet start-up company. At that time you agreed to use your sliding scale to reduce your fee to accommodate Arlen since after six months a solid therapeutic bond was in place. From a professional practice standpoint, which is most important to do at this time?
Definition
Discuss with Arlen under what circumstances, such as obtaining a new job, you will re-establish his original fee structure.

When making a temporary fee reduction, in order to maintain clear, ethical boundaries about fees and payments, you should make certain Arlen knows the expectations about when you will resume charging him his original, customary fee.
Term
You are treating a client who discloses that she has had sexual relations with all her prior therapists. You:
Definition
Provide her with a copy of "Professional Therapy Never Includes Sex" and answer her questions about it.

Your legal responsibility is to provide the pamphlet "Professional Therapy Never Includes Sex" and discuss it with the client if he or she informs you of sexual misconduct between him/herself and a therapist.
Term
The law requires therapists to adhere to particular time frames when meeting standards for professional conduct. Which of the following is accurate?
Definition
Client records that are stored on a hard drive on a computer must be retained for a minimum of seven years after the client terminates.

The law requires that therapists retain records for a minimum of seven years after a client terminates therapy, in any medium those records exist.
Term
June discloses that she had been molested by a step-brother when she was 15. She is now 28 and was divorced from her husband three years ago. Before seeing you, she saw another therapist and she has just told you that she had sex with him. She wants therapy to focus on the stormy relationship issues that led to her divorce, not on past sexual molestation or exploitation. You would:
Definition
Give her the brochure "Professional Therapy Never Includes Sex" and discuss her options.

When a client reveals that s/he has had sex with a former therapist, the treating therapist is required to give her/him the brochure "Professional Therapy Never Includes Sex," as well as discuss it with them.
Term
Your former supervisor refers a client to you and suggests that you split the client fee as you did while under her supervision. You would:
Definition
Inform the supervisor that it is illegal to split fees.

It is not legal to split fees; the client is only paying one person for services.
Term
Your client works as a pilot and often misses appointments because she is called out-of-town at the last minute. When billing her insurance, you:
Definition
Note carefully which sessions the client actually attended.

It is vital to clearly note which sessions were missed on the bill (which will be sent to the insurance company) or this is insurance fraud.
Term
You are treating a 52-year-old man who is helping his father prepare a will. Your client tells you that he wants to make sure that the estate is "fair" for himself and his brother. He says, "I probably am not objective with all this, what should I do with his will?" Which legal principle is triggered in this situation for you as his therapist?
Definition
Scope of practice.

It is important for therapists not to make decisions for their clients that are out of the MFT scope of practice.
Term
A famous rock musician who can pay your top fee is referred to you by a colleague. You send your colleague a bottle of fine wine in gratitude. Which of the following statements is TRUE about this situation? You have:
Definition
Acted unethically and illegally.

Although the gift is not substantial in value, therapists are prohibited by law and ethical standards from accepting or providing any kind of remuneration for referrals.
Term
The O'Rourkes have been married for 4 years. They have one child, Megan who is 14, and in individual therapy. You have been treating her for what you thought was Bulimia. Tina says that she and her husband are worried that Megan may be anorexic since they found her internet searches on anorexic websites. If they want to pay with insurance, you would:
Definition
Obtain confirmation about their benefits before the first session.

You would need to confirm the client's benefits (payment policy set by the insurance company) before starting therapy. This is equivalent to setting the fee before therapy.
Term
A newly-licensed therapist wants to establish her practice. She goes to several neighborhood psychiatrists and doctors advertising her practice and offering small tokens of appreciation in return. What is the problem here?
Definition
It is not legal for her to offer compensation for referrals.

It is illegal for mental health professionals to offer compensation or rewards for referrals.
Term
You have been treating Anita for three sessions for depression and relationships issues. You are considering a diagnosis of Major Depression and other DSM-5 diagnoses. You are not sure which is appropriate yet. Legally:
Definition
Change the diagnosis when you have confirmed it on any insurance forms.

To avoid fraud you would have to code the diagnosis you currently are considering and change it when necessary
Term
Eugenia, a 36-year-old massage therapist from Brazil is referred by a former client. She presents in a highly agitated manner and occasionally slurs her words as she tells you that her ex-husband is stalking her and her 16-year-old daughter. She is considering obtaining a temporary restraining order against him. Eugenia has no health insurance and wants to know if you can extend credit to her or receive massages in exchange for therapy. What is your legal course of action?
Definition
Refer to legal aid for restraining order help or to assist with assault charges.

Eugenia is thinking about a temporary restraining order, and the help of a therapist would give would be in directing her to the appropriate resources. It would be out of your scope of practice to give her legal advice yourself.
Term
Your client says that she had sex with her former therapist, a marriage and family therapist, but that she initiated it and she broke off the therapy so she could continue to see him socially. What do you do?
Definition
Give her the brochure "Professional Therapy Never Includes Sex" and discuss the contents with her.
CORRECT.

Therapists are legally required to provide the client with the brochure, "Professional Therapy Never Includes Sex" and discuss its contents.
Term
Which of the following is not considered by law to be unprofessional conduct by a therapist?
Definition
Being arrested for shoplifting.

The law (Business and Professions Code 4982(a) says unprofessional conduct addresses licenses or registrants who have been "convicted" of an offense, not just arrested.
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