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Necessary Secrets: Ethical Dilemmas Involving Confidentiality - Test
by Gerald P. Koocher, Ph.D., ABPP and Patricia Keith‑Spiegel, Ph.D.

Course content © copyright 2009-2021 by Gerald P. Koocher, Ph.D. and Patricia Keith-Spiegel, Ph.D.. All rights reserved.

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1. Court decisions have supported the concept that psychotherapist-client privilege may: Help
Apply in Federal court.
 Extend beyond a client's death.
 Not protect spies in therapy.
 All of the above
2. What recent developments have substantially complicated the ability to maintain confidentiality? Help
Digital communication and databases
 Court decisions eliminating client privilege
 The legal requirement that therapists disclose information to any family member
 All of the above
3. One way to differentiate between the related concepts of confidentiality, privilege, and privacy, is that _____ is protected by the Constitution, _____ is primarily a legal concept, and _____ is chiefly a professional standard. Help
Confidentiality, privacy, privilege
 Privacy, confidentiality, privilege
 Privacy, privilege, confidentiality
 None of the above is in the correct order.
4. The Landmark Supreme Court case of Jaffe v. Redmond (1996) set a Federal (national) standard in the area of: Help
Freedom of speech.
 Privileged communication.
 Spousal confidentiality.
 Clergy confidentiality.
5. Privileged communication is a right granted by common law, case law, or statute to: Help
The psychotherapist.
 The client.
 Conversations among professional colleagues.
 The military.
6. When law and ethical standards on matters of confidentiality appear to diverge the ethically best practice would be to: Help
Actively seek consultation to resolve the conflict.
 Obey the law as written.
 Obey the professional ethics code as written.
 Seek input from the client as to their personal perspective.
7. Mandated reporting laws require licensed mental health professionals to breach confidentiality and report: Help
Suspected abuse of children or other vulnerable persons.
 All felonies.
 All misdemeanors.
 Situations in which the clinician fears that the client may attempt to manipulate others.
8. Under the so-called Tarasoff doctrine (Tarasoff v Board of Regents of the University of California) a therapist may have an obligation to: Help
Report all potentially violent clients to the police.
 Maintain confidentiality without exception.
 Take steps to protect identified third parties when a client threatens to harm them.
 Refuse services to potentially dangerous clients who refuse to sign "no harm contracts."
9. Recent court decisions have made it clear that enforcement of the duty to protect third parties from harm, first articulated in the Tarasoff case: Help
Can vary significantly by state.
 May soon disappear as a responsibility of therapists.
 Can be ignored if a client has never acted of homicidal ideation before.
 Does not apply to patients under age 18.
10. A consent form authorizing the release of protected health care information does NOT require one of the following elements. What is NOT required? Help
The signature of the client or their legal representative/guardian
 An expiration date
 Specification of the recipient person or agency
 Itemization of fees paid.
11. A therapist should generally assume that client's access to his/her own records is: Help
Generally allowed under HIPAA.
 Generally prohibited under HIPAA.
 Not addressed under HIPAA.
 Regulated largely by state law.
12. In which of the following situations might breaking confidentiality be appropriate? Help
A client tells you that he hates his teacher and would be happy if she had a heart attack.
 A client tells you she is planning to kill herself this evening.
A client tells you that he is thinking about robbing a bank.
 None of the above would qualify as a justifiable reason to break confidentiality.
13. Opponents of open client access to records make what argument? Help
The therapist must feel free to speculate and jot down any thought or comments, some of which will invariably seem erroneous or misleading if taken out of context.
 The records could be unintelligible to a layperson and the revelations may serve no useful purpose.
 Harm may follow release of technical professional information to clients who are not equipped to deal with it.
 All of the above
14. When receiving a subpoena for a client's records, the therapist should: Help
Immediately hand over original copies of everything requested.
 Notify the client or their attorney and assess the validity of the document.
 Assert therapist's privilege.
 Delete any embarrassing notes from the record.
15. The 21st Century Cures Act has important implications for mental health practice because it: Help
Regulates integration of electronic medical records.
 Uses the patient as a connecting link to health care Institutions, payers, and providers.
 Provides for expanded patient access to practitioner's notes.
 All of the above.
16. Under the 21st Century Cures Act one can decline to share protected electronic health information (EHI) for all of the following reasons EXCEPT to: Help
Prevent harm.
 Avoid inconvenience.
 Protect privacy.
 Protect security of the EHI.
17. When clients decide to submit a claim for mental health benefits to an insurance company (or authorize a therapist to do so on their behalf), they may not realize that: Help
In so doing, they have authorized the provider of services to share confidential information.
 Their premium rates will immediately increase significantly.
 The therapist will share this information with colleagues.
 The insurance company will decline reimbursement.
18. If a psychotherapist learns information from a therapy client about an impending business merger that is not yet known to the public: Help
The therapist should seek further advice before investing in either company.
 The information can readily be shared in private with others.
 The therapist has a duty to alert the Securities and Exchange Commission.
 Making an investment that seeks to profit on the information would be unethical.
19. When considering the security of client records stored electronically clinicians need to concern themselves with all of the following EXCEPT: Help
HIPAA compliance certification of any cloud back-up service.
 Shielding from solar flare activity.
 Adequacy of password complexity and updating.
 Removal of data from old computers, external drives, and copiers before disposal.
20. A clinician decides to save space by digitizing clinical files with a new high speed scanner. Which of the following plans to dispose of the old paper records would be LEAST appropriate: Help
Hiring a commercial shredding company willing to certify HIPAA compliance to pick up the files for remote shredding.
 Hiring a commercial shredding company willing to certify HIPAA compliance to pick up the files for on site shredding at the clinical office.
 Hiring their 16 year old child to tear up the records and bag them for the city's recycling truck.
 Inserting the files in a locked shredding bin at a local UPS or STAPLES store.
21. Which of the following is NOT true with respect to a therapist's case files? Help
Outdated, obsolete materials should be culled from the files.
 The IRS may review client records upon request.
 A therapist should specify a means of disposition in the event of his/her death.
 Standards on required duration of retention vary from state to state.
22. What are the two key factors a therapist should consider in making a decision about retention or disposition of records? Help
Client welfare and therapist welfare
 At least two years have passed since the last visit and diagnosis
 Any applicable legal obligations and client welfare
 Diagnosis and insurance company
23. Good ethical practice in managing electronic records requires understanding: Help
Encryption.
 Hazards of using wireless devices.
 Role-segregation.
 All of the above.
24. In order to avoid errors when using electronic medical records clinicians should: Help
Take care to avoid repeating incorrect information.
 Take care to avoid cut and paste errors.
 Guard against electronic routing errors.
 All of the above

 

 

  
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