SCOPE OF PRACTICE AND COMPETENCE

Therapists do not provide services unless they have adequate training and experience to work with the client’s presenting problems and cultural needs.

Therapists work within their scope of practice, ie they do not attempt to give services that would require training or licensure in other fields or disciplines. Common examples are medical and legal advice.

Therapeutic Relationship

Law and Ethics Nuts and Bolts

The BBS says the scope of practice for an LCSW is: “a service in which a special knowledge of social resources, human capabilities, and the part that unconscious motivation plays in determining behavior, is directed at helping people to achieve more adequate, satisfying, and productive social adjustments,” which includes “counseling and using applied psychotherapy of a nonmedical nature with individuals, families, or groups; providing information and referral services; providing or arranging for the provision of social services; explaining or interpreting the psychosocial aspects in the situations of individuals, families, or groups; [and] helping communities to organize, to provide, or to improve social or health services; or doing research related to social work.”

And the scope of practice for an MFT is “service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and premarriage counseling” and includes “the use of applied psychotherapeutic techniques, to enable individuals to mature and grow within marriage and the family, [and] the provision of explanations and interpretations of the psychosexual and psychosocial aspects of relationships.”

CONSENT TO TREATMENT

“Informed consent” means that a client understands the risks and benefits of therapy before starting. This may include letting couples know that therapy will not necessarily help them stay together, or letting a client know that therapy may make them feel better but may also bring up painful feelings.

Informed consent includes making the client aware of common exceptions to confidentiality. (See Exceptions to Confidentiality fact sheet.)

Children normally need an adult to give legal consent for their treatment. (See Consent to Treat Minors fact sheet.)

As of July 1, 2020, all licensees and registrants must provide clients with a notice in at least 12-point font, that substantially states the following:

NOTICE TO CLIENTS
The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at www.bbs.ca.gov, or by calling (916) 574-7830.​

FEE SETTING

Legally, a therapist must establish a client’s fee by the end of the first session. Many therapists prefer to set a fee before meeting with a client at all.

In one legal case, a client sued a therapist for letting her owe him money for sessions. The court said he should have foreseen that her debt would compromise the therapeutic trust, and he should have referred her to affordable therapy.

CLIENT SAFETY AND WELFARE

Therapists identify and address issues that threaten a client's safety and welfare, such as substance abuse, domestic violence, self-injury, and self-endangerment.

When a client has suicidal intent, is unable to contract not to act on it, and is unwilling to be hospitalized voluntarily, the therapist must initiate a 5150.

DUAL RELATIONSHIPS

It is unethical to have a dual relationship with a client or anyone close to the client, unless the relationship is 1) unavoidable, 2) non-exploitive, 3) non-sexual, and 4) not disruptive to the therapeutic alliance.

Avoidable dual relationships would include 1) any financial relationship other than paying for therapy (lending, hiring, etc), or 2) any close personal relationship.

SEXUAL CONTACT

It is illegal to have sexual contact with a client.

If a therapist learns that another therapist had sexual contact with a client, the therapist must offer the client a copy of the BBS booklet “Professional Therapy Never Includes Sex.”

It is unethical to provide therapy to a person with whom the therapist had a past sexual relationship.

It is unethical to terminate therapy in order to be able to have a sexual relationship with a client.

It is unethical to have a sexual relationship with a client’s family member or anyone close to a client.

Most ethical codes say it is unethical ever to have a sexual relationship with a former client. CAMFT states it may be ethical to do so two years after termination.

Physical contact of any kind with a client should be avoided when possible, and therapists should not initiate it.

CONFLICTS OF INTEREST

Some conflicts are not dual relationships in a personal way, and they don’t involve exploiting a client, but they do compromise the therapist’s ability to provide services.

It is not ethical to provide therapy to a person for whom you have done a forensic or custody evaluation.

Other examples might include treating a client while also treating someone close to them, someone with whom they have a financial or work relationship, or someone with whom they have a legal conflict.

TERMINATION

It is unethical to keep a client in therapy solely for the therapist’s financial gain, or to keep a client when therapy is not helping.

It is unethical to abandon a client. When it is necessary for a therapist to stop seeing a client who would prefer to continue, best practice is to provide adequate notice and referrals.

Clients have a right to terminate their therapy at any time and are not obligated to give a reason or give notice. Best practice is still to invite the client to discuss the reasons and offer further therapy session(s) forclosure.