Gifts
What are the most important things to consider when deciding whether or not to accept a gift?
The meaning of the gift, the price of the gift, timing, intention, and cultural reasons for it.
What are things you should discuss with your client before attending an event with or for them? There are four answers — you must get at least two for the point!
Confidentiality, unexpected situations, dual relationships, and expectations for the event
What must a therapist do in a Tarasoff situation?
Fulfill the duty to protect by notifying police and taking reasonable steps to identify and warn the potential victim.
Under what conditions may a minor consent to their own treatment?
The minor must be 12 or older, mature enough to participate intelligently in therapy, and responsible for payment. The therapist must also document whether the minor was asked about involving their parents.
Your client gives you the following letter, “My dear therapist, I think about you every waking moment of the day and as I fall asleep at night. Your eyes remind me of the deep sea, and I just want to swim in them. Your laugh is like bells on a beautiful summer day in the Jersey Shore. I do not want to live without you, please don’t ever leave me. I do not know what I would do without you.” How would you respond to receiving this letter?
You must think about the context, client history, diagnosis and other factors that contribute to the meaning behind the gift. Given the romantic nature of the letter, you should politely decline without making your client feel outwardly rejected.
Your client invites you to their birthday party and informs you the theme is champagne and shackles. They assure you that they are fine with any party guests knowing you are their therapist, and they even ask you to be their partner. This means you will be handcuffed to your client until the two of you finish drinking an entire bottle of champagne. Do you say yes?
NO
Your client often vents about people parking in front of the apartment building that he lives in. He says that it makes his life more difficult and adds more stress during his day. He is particularly stressed in one session and states that he “wants to kill them all.” What would you do next?
Ask for more information about his intention behind the comment, and decipher between venting and harmful intent.
What allows a grandmother caring for her 11-year-old grandson to authorize mental health treatment without the parents present?
She must sign a caregiver authorization affidavit.
You have been seeing your client, Makayla, for almost 8 months, when one day she shows up with a cake pop for the two of you, along with her usual starbucks latte. You converse about the gift intention, and she informs you that it’s her birthday. Because this is a special occasion, you accept the gift and let her know that the cake pop is very good, and thank her. Since that session, she has begun to bring you a cake pop (but not one for herself) every single session. Is this continued cake pop gift ethical? Why, or why not?
No. This was fine once for a special occasion, but now you need to talk about why she is continuing to bring you a cake pop. What if she feels obligated to? You definitely need to clear that up. Besides, what if you don’t want a cake pop one day, and she takes offense?
Your client whom you have been seeing for 5 months, asks if you would attend their Alcoholics Anonymous meeting next week, when they will be receiving their 6-month chip marking their sobriety. They are fine with people knowing you are their therapist if it comes up. You think that there may be previous clients you have served at this meeting, as this is a small community and you tend to run into the same people. Should you attend with your client?
Talk to your client about the risks of running into family, friends, and other community members, then decide together if attending is therapeutically beneficial.
A client’s sister calls the therapist and says, “Your client is outside his ex-boyfriend’s apartment with a water balloon launcher and expired Chobani Berry Blast yogurt, screaming, 'HE WILL PAY FOR THIS'. Which Tarasoff criteria are met, and which criterion may not be satisfied?
The imminent threat and identifiable victim criteria are likely met, but the grave bodily harm criterion is not because yogurt is unlikely to cause serious bodily injury.
You have a client come in for their first session. They claim that they are 12 years old and therefore, don’t need their parents' consent to receive therapeutic treatment from you. However, you would estimate that this client looks no older than 8 years old. What do you do next?
As a therapist, you don't legally have to investigate. If your client tells you they are 12 years old, you don’t have to prove it. They might lie to you, and that’s a possibility that’s out of your control. However, you can ask them to bring something to help identify them as 12 years old, such as their report card indicating their grade in school.
You have a client who is from East Asia, and she goes back to visit her family. She brings back a trinket from her grandmother’s house, and says she wants you to have it because of how much the work in therapy has meant to her. What are your next steps to know whether or not to accept the gift?
Talk to her about what the gift means and why it's significant, especially given how close it is to her family
You've been seeing Noah for 3 years, where he has been working through his long-term breakup with the love of his life, Allie. Noah tells you Allie is getting married to a man named Lon and he's been invited. He asks you to attend as his plus one so he has someone to comfort him and so he "doesn't cause a scene" — but he does not want Allie or any guest to know you are his therapist and asks you to pretend to be his date. You genuinely believe attending is a crucial step for Noah to move on, but he says he will only go if you come with him. Do you say yes?
This is an ethical issue.
No. While attending may seem therapeutically beneficial, pretending to be his date crosses ethical boundaries, misrepresents the therapeutic relationship, and creates serious risk for a dual relationship and potential boundary violations.
A client tells their therapist, “Tonight I’m going to my ex-boyfriend’s house, and I’m going to stab him.” The client provides the ex-boyfriend’s name and says they already have a knife in their car. What Tarasoff criteria are present, and what should the therapist do?
The client has made an imminent threat toward a reasonably identifiable victim with risk of grave bodily harm, so the therapist has a duty under Tarasoff to breach confidentiality by notifying police and taking reasonable steps to protect the intended victim.
Your 14-year-old client, who wants to receive therapy without parental consent, discloses that they will be using their dad's credit card for sessions. How should you proceed?
Let the client know that proceeding without parental consent requires them to be responsible for payment, which means not using Dad's credit card. If they want to use it, parental consent is required.
Your client, Jeff Bezos, a billionaire, gives you a Birkin designer purse (worth $30k) because his 4th wife declined it since “it was so last season”. He doesn’t want it to go to waste, and otherwise will just throw it out. Do you accept the Birkin?
Even though it's a Birkin, you should explore with Jeff why he felt the need to give the purse to you, what it would mean if you accepted it, and how it would impact your therapeutic relationship.
You've been seeing Bill and Nancy as their couples therapist for 2 years. A year in, after a near-fatal car accident, they asked you in session to attend their funerals if anything happened to them — you agreed, and it was never brought up again. Bill suddenly passes away from a heart attack. Nancy asks you to attend the funeral. Do you go?
Since you never obtained written consent from both participants in couples therapy, you cannot go to the funeral. The couple is the unit of treatment, and going would put Bill’s confidentiality at risk.
A therapist’s client denies wanting to hurt anyone during the session. Later that night, the client’s brother calls and says the client is driving to his ex-girlfriend’s house with a weapon, threatening to “end this tonight.” The brother provides the ex-girlfriend’s name and address. What should the therapist do under Tarasoff?
You must notify the police and take reasonable steps to protect the intended victim
Your 13-year-old client meets the requirements to consent to their own treatment. Their mother somehow obtains your contact information, already knows you see their child, and demands that you send over detailed session notes. How do you respond?
Do not confirm or deny that you see the child for therapy. Since the minor is self-consenting, you cannot legally release session notes to the parent, even though she is the mother and is demanding them.