Ethics & Boundaries
A client sends their therapist a friend request on social media and says, “I just want to follow you because your posts are inspiring.” What is the therapist’s BEST response?
Decline the request and discuss professional boundaries and the potential impact of social media contact on the therapeutic relationship.
A client becomes tearful during an intake and says, “Everything is falling apart.” What should the social worker do FIRST?
Explore what the client means and assess the presenting concerns.
A client has experienced depressed mood, loss of interest, fatigue, poor concentration, sleep disturbance, and feelings of worthlessness for three weeks. What diagnosis should be considered?
Major Depressive Disorder.
A supervisee repeatedly submits documentation late. What should the supervisor do FIRST?
Address the pattern directly, clarify expectations, and explore barriers to timely documentation.
A client reports passive suicidal thoughts but denies plan or intent. What should the therapist do?
Complete a comprehensive suicide risk assessment rather than assuming passive thoughts mean low risk
A therapist realizes that a new client attends the same church as the therapist. They have seen each other several times but have never personally interacted. What should the therapist do FIRST?
Assess the potential for a dual relationship and discuss confidentiality and boundary concerns with the client.
A client says, “Sometimes I think everyone would be better off if I weren't here.” What should the therapist do FIRST?
Conduct a suicide risk assessment.
A client reports excessive anxiety about finances, health, family, and work occurring most days for approximately eight months. They have difficulty controlling the worry and report muscle tension, irritability, and sleep problems.
Generalized Anxiety Disorder.
A supervisee admits they have never treated eating disorders but accepted a client with severe eating-disorder symptoms because they “wanted the experience.” What should the supervisor address FIRST?
The supervisee's competence to provide the needed services and the client's immediate clinical needs.
A client says, “My boyfriend is going to regret what he did to me.” When asked what they mean, the client says, “Don't worry about it.”
What should the therapist do FIRST?
Further assess for homicidal or violent ideation, including intent, plan, means, target, and relevant risk/protective factors.
A therapist receives a subpoena requesting a client’s complete record. What should the therapist do FIRST?
Review the subpoena and applicable confidentiality requirements and consult with a supervisor, agency policy, and/or appropriate legal resources before releasing information
A client repeatedly arrives 20 minutes late. The therapist is becoming frustrated. What is the BEST response?
Explore the pattern with the client and determine what may be contributing to the lateness.
A client experiences recurrent unexpected panic attacks and has spent the past two months worrying about having another attack.
Panic Disorder.
A supervisee becomes defensive every time feedback is provided. What is the supervisor's BEST approach?
Explore the supervisee's response to feedback while maintaining clear performance expectations.
A child tells a therapist something suggesting possible abuse but then says, “Please don't tell anyone.”
What is the therapist's priority?
Assess the disclosure and follow applicable mandated-reporting requirements while explaining the limits of confidentiality appropriately.
A supervisee tells their supervisor, “My client reminds me so much of my younger sister that I feel extremely protective of her. I sometimes find myself telling her what she should do.” What should the supervisor BEST address?
Explore possible countertransference and how it may be influencing the supervisee’s clinical judgment.
A supervisee says they believe their client has borderline personality disorder after only one session. The client has a trauma history, unstable relationships, emotional dysregulation, and recent grief. What should the supervisor recommend FIRST?
Gather additional assessment information before confirming the diagnosis.
A 29-year-old client experiences hallucinations and delusions for eight months. They also have significant depressive episodes, but hallucinations have occurred for several weeks when a major mood episode was absent.
Schizoaffective Disorder should be considered.
A supervisee tells their supervisor that a client regularly texts them late at night about non-emergency concerns. The supervisee responds because they feel guilty ignoring the client.
What should the supervisor BEST recommend?
Establish and communicate clear communication and emergency-contact boundaries while exploring the supervisee's difficulty maintaining those boundaries.
A client experiencing psychosis says voices are telling them to hurt themselves. They appear frightened and report that the voices are becoming increasingly difficult to resist. What should the therapist do FIRST?
Immediately assess suicide/self-harm risk, command hallucinations, intent, ability to resist the commands, access to means, and need for a higher level of care.
A long-term client gives their therapist a handmade item worth approximately $10 at termination and says making it helped them process the end of therapy. What should the therapist do?
Explore the meaning of the gift and consider cultural factors, clinical implications, agency policy, and boundary concerns before deciding whether to accept it.
A client becomes angry after the therapist challenges a cognitive distortion and says, “You clearly don't understand me.” What should the therapist do NEXT?
Explore the client's reaction and address the possible therapeutic rupture.
A client reports decreased need for sleep, pressured speech, racing thoughts, increased goal-directed activity, and impulsive spending for eight days. Their functioning has become significantly impaired.
A manic episode should be considered, which may support Bipolar I Disorder after full diagnostic assessment.
A supervisee reveals that they changed information in a progress note after learning an insurance audit was coming because “the original note wasn't detailed enough.” What should the supervisor do FIRST?
Clarify exactly what was changed and why, assess whether the record was improperly altered, and follow applicable documentation, agency, ethical, and legal requirements.
A supervisee calls and says, “My client told me they're suicidal, so I immediately called the police.” What is the most important issue for the supervisor to explore?
Whether the supervisee completed an adequate risk assessment and used the least restrictive clinically appropriate intervention based on the level of risk.