NCMHCE - National Clinical Mental Health Counseling Examination Professional Practice and Ethics 2 — Questions and Answers
Question 1: A licensed counselor receives a subpoena for a client's therapy records. What is the counselor's FIRST ethical obligation?
- Immediately comply with the subpoena and release records
- Contact the client to inform them and discuss options (Correct answer)
- Refuse to release records based on confidentiality
- Contact their own attorney for legal advice
Correct answer: Contact the client to inform them and discuss options
The counselor's first obligation is to inform the client about the subpoena and discuss their options, including the possibility of asserting privilege.
When a counselor receives a subpoena for client records, the first step is to contact the client because privilege belongs to the client, not the counselor. A subpoena alone does not override therapeutic privilege; a court order is required.
Question 2: A counselor's former client, whom they terminated with 18 months ago, asks the counselor on a date. According to the ACA Code of Ethics, which response is MOST appropriate?
- Accept, since the therapeutic relationship has ended
- Decline, as romantic relationships with former clients are prohibited for 5 years (Correct answer)
- Accept only if the counselor determines it would not be exploitative
- Decline permanently, as romantic relationships with former clients are never permitted
Correct answer: Decline, as romantic relationships with former clients are prohibited for 5 years
The ACA Code of Ethics requires a minimum 5-year waiting period after termination before any romantic relationship with a former client.
ACA Code of Ethics Section A.5.b states that counselors must not engage in romantic or sexual relationships with former clients for a minimum of 5 years following the last professional contact. Even after 5 years, the counselor bears the burden of demonstrating the relationship is not exploitative.
Question 3: A counselor discovers that a colleague is practicing under impairment due to substance abuse. According to the ACA Code of Ethics, what is the counselor's obligation?
- Report the colleague directly to the state licensing board
- Encourage the colleague to seek help and address the impairment (Correct answer)
- Maintain silence to protect the colleague's privacy
- Confront the colleague publicly to protect clients
Correct answer: Encourage the colleague to seek help and address the impairment
The ACA Code of Ethics requires counselors to first assist impaired colleagues by encouraging them to seek help, with reporting as a subsequent step if needed.
ACA Code of Ethics Section C.2.g addresses counselor impairment. The first step is to approach the impaired colleague directly, express concern, and encourage them to seek treatment. If the colleague does not address the impairment, then reporting becomes necessary.
Question 4: In a managed care environment, an insurance company denies continued authorization for a client who the counselor believes still needs treatment. What is the counselor's PRIMARY ethical obligation?
- Terminate treatment as directed by the insurance company
- Continue treatment pro bono regardless of payment
- Advocate for the client by appealing the denial and documenting medical necessity (Correct answer)
- Refer the client to a community mental health agency
Correct answer: Advocate for the client by appealing the denial and documenting medical necessity
The counselor has an ethical obligation to advocate for the client's continued treatment by appealing insurance denials and documenting medical necessity.
ACA Code of Ethics Section A.1.a establishes that client welfare is the primary responsibility. When insurance denies authorization that is clinically necessary, the counselor must advocate through the appeals process with thorough documentation.
Question 5: A counselor is asked to provide expert testimony in a child custody case for a family they are counseling. What is the MOST ethically appropriate response?
- Provide testimony since they know the family well
- Decline and recommend an independent custody evaluator (Correct answer)
- Provide testimony only if both parents consent
- Agree to testify for the parent who is the identified client
Correct answer: Decline and recommend an independent custody evaluator
Serving as both therapist and forensic evaluator represents a harmful dual role. The counselor should recommend an independent evaluator.
ACA Code of Ethics Section A.6 prohibits serving in dual roles that could impair professional judgment. A counselor with a therapeutic relationship cannot also serve as an objective forensic evaluator in a custody dispute.
Question 6: Under HIPAA, which of the following situations permits disclosure of protected health information WITHOUT client authorization?
- When a family member requests information about the client's treatment
- When required by a state mandatory reporting law for suspected child abuse (Correct answer)
- When another mental health professional requests records for research
- When the client's employer requests fitness-for-duty information
Correct answer: When required by a state mandatory reporting law for suspected child abuse
Mandatory reporting laws for suspected child abuse are a legally recognized exception to HIPAA's authorization requirement.
HIPAA permits disclosure of protected health information without client authorization when required by law. Mandatory reporting of suspected child abuse is a legal requirement in all 50 states that overrides both therapeutic confidentiality and HIPAA privacy protections.
NCMHCE - National Clinical Mental Health Counseling Examination Professional Practice and Ethics 2
A licensed counselor receives a subpoena for a client's therapy records.
What is the counselor's FIRST ethical obligation?