CBT Ethics & Professional Practice 3 — Questions and Answers
Question 1: A CBT therapist is approached by a client's spouse requesting to join a session to 'help.' The client has not mentioned this request. What is the first ethical step?
- Allow the spouse to join to demonstrate transparency
- Contact the spouse to discuss their concerns privately
- Discuss the request with the client and obtain their explicit consent (Correct answer)
- Decline the spouse's request without informing the client
Correct answer: Discuss the request with the client and obtain their explicit consent
The client's autonomy and confidentiality must be respected; any third-party involvement requires the client's informed consent and should be discussed openly with them.
Question 2: Which scenario most clearly illustrates boundary crossing versus boundary violation in CBT practice?
- Accepting a small gift from a client at termination versus having a sexual relationship with a client (Correct answer)
- Using cognitive restructuring versus exposure therapy techniques
- Taking notes during session versus recording sessions
- Charging a sliding scale fee versus a fixed fee
Correct answer: Accepting a small gift from a client at termination versus having a sexual relationship with a client
A boundary crossing is a minor deviation that may or may not be harmful (like accepting a small gift), while a boundary violation is a serious ethical breach that causes harm (like sexual involvement).
Question 3: A CBT therapist discovers they are experiencing significant countertransference that is affecting their clinical judgment with a particular client. The most ethical action is to:
- Immediately terminate treatment with the client
- Seek personal therapy and/or clinical supervision to address the countertransference (Correct answer)
- Disclose the countertransference fully to the client
- Avoid discussing the topics that trigger the countertransference
Correct answer: Seek personal therapy and/or clinical supervision to address the countertransference
Seeking supervision and/or personal therapy allows the therapist to process countertransference without compromising client care or burdening the client with the therapist's issues.
Question 4: When is it ethically acceptable to provide CBT services via telehealth?
- Only when the client lives more than 50 miles from the therapist's office
- When the therapist is licensed in the client's jurisdiction and telehealth is clinically appropriate (Correct answer)
- Whenever the client prefers it, regardless of other considerations
- Only with written approval from the therapist's professional association
Correct answer: When the therapist is licensed in the client's jurisdiction and telehealth is clinically appropriate
Telehealth is ethically permissible when licensure requirements are met for the client's location and the modality is appropriate for the client's clinical needs.
Question 5: A client in CBT discloses past child abuse perpetrated by their parent, who is not a current threat. What is the therapist's ethical and legal obligation?
- Report immediately to child protective services regardless of the client's current age
- Assess the situation; mandatory reporting applies when there is a current risk to a child, not solely historical abuse (Correct answer)
- Keep all disclosures confidential as there is no current threat
- Consult with an attorney before taking any action
Correct answer: Assess the situation; mandatory reporting applies when there is a current risk to a child, not solely historical abuse
Mandatory reporting is typically triggered by current or ongoing risk to a child; historical abuse involving no current risk to a child generally does not require a report, though laws vary by state.
Question 6: What does the ethical principle of 'nonmaleficence' require of a CBT therapist?
- Actively promoting the client's wellbeing through therapeutic interventions
- Avoiding actions that cause harm to clients, even when well-intentioned (Correct answer)
- Treating all clients equitably regardless of background
- Respecting clients' right to make their own decisions
Correct answer: Avoiding actions that cause harm to clients, even when well-intentioned
Nonmaleficence means 'do no harm' and requires therapists to avoid actions, even well-meaning ones, that could cause harm to clients.
Question 7: A client asks their CBT therapist to write a letter supporting their disability claim. What ethical consideration is most important?
- Refusing all requests for letters to maintain neutrality
- Assessing whether the request falls within the therapist's competence and whether the content is accurate (Correct answer)
- Writing the letter to strengthen the therapeutic alliance
- Charging an extra fee for any third-party documentation
Correct answer: Assessing whether the request falls within the therapist's competence and whether the content is accurate
Therapists must only provide documentation they are qualified to give and that accurately reflects clinical findings, as fraudulent or inflated statements cause harm and violate ethical standards.
CBT Ethics & Professional Practice 3
A CBT therapist is approached by a client's spouse requesting to join a session to 'help.' The client has not mentioned this request.
What is the first ethical step?