NCMHCE Professional Practice and Ethics 5 — Questions and Answers
Question 1: A counselor accepts a client's offer of a homemade gift worth approximately $10 at the end of a successful treatment. According to the ACA Code, this is:
- Always prohibited as it constitutes a dual relationship
- Potentially acceptable after considering cultural context, therapeutic relationship, and motivation (Correct answer)
- Acceptable only if the gift is donated to charity
- Prohibited unless the supervisor approves in writing
Correct answer: Potentially acceptable after considering cultural context, therapeutic relationship, and motivation
The ACA recognizes that small gifts in certain cultural contexts may not be harmful, and counselors should use judgment considering the client's motivation and cultural meaning.
Question 2: Which of the following scenarios MOST clearly requires a counselor to break confidentiality without client consent?
- A client describes ongoing marijuana use in a state where it is illegal
- A client discloses they have been HIV positive for years and are having unprotected sex with an unknowing partner (Correct answer)
- A client reports past domestic violence perpetration that ended two years ago
- A client expresses anger toward their employer but no specific threat
Correct answer: A client discloses they have been HIV positive for years and are having unprotected sex with an unknowing partner
An identifiable third party at ongoing, serious risk of physical harm from the client's knowing conduct may trigger a duty-to-warn obligation depending on state law.
Question 3: A counselor is asked by a court to evaluate a client they have been treating for 18 months. The counselor should:
- Accept the dual role because long-term knowledge of the client is clinically valuable
- Decline the forensic evaluator role and recommend a separate, independent evaluator (Correct answer)
- Conduct the evaluation only if the client provides written consent
- Accept only if the court issues a formal order compelling participation
Correct answer: Decline the forensic evaluator role and recommend a separate, independent evaluator
Combining a therapeutic role with a forensic evaluation role creates a fundamental dual-relationship conflict that compromises both functions.
Question 4: When a minor client's parents request access to their child's therapy records, the counselor should FIRST:
- Release all records because parents have automatic legal authority over minors
- Assess the minor's age, applicable state law, and the type of services provided before determining access rights (Correct answer)
- Refuse all access to protect the minor's confidentiality
- Contact the insurance carrier to determine who the identified patient is
Correct answer: Assess the minor's age, applicable state law, and the type of services provided before determining access rights
Minors' record access rights vary by state, age, type of treatment, and whether the minor consented to treatment independently, requiring careful legal and ethical analysis.
Question 5: A counselor discovers they share the same online support group as a current client. The MOST appropriate response is to:
- Immediately disclose to the client and discuss the implications for therapy
- Withdraw from the support group to avoid the dual relationship (Correct answer)
- Continue participating but avoid all contact with the client in the group
- Do nothing because online spaces are personal and separate from clinical work
Correct answer: Withdraw from the support group to avoid the dual relationship
The counselor's participation creates a dual relationship; the least disruptive resolution is typically the counselor withdrawing from the shared space.
Question 6: The concept of 'fidelity' as an ethical principle in counseling primarily involves:
- Avoiding financial exploitation of clients
- Honoring commitments and being trustworthy in the therapeutic relationship (Correct answer)
- Ensuring clients' best interests override institutional policies
- Providing consistent treatment regardless of payment status
Correct answer: Honoring commitments and being trustworthy in the therapeutic relationship
Fidelity refers to faithfulness to professional commitments and the cultivation of trust as the foundation of the therapeutic relationship.
Question 7: A counselor who practices in a state without specific telehealth regulations wants to provide services to a client who has relocated to another state. The counselor should:
- Continue services uninterrupted because the original state license covers all telehealth
- Research licensure requirements in the client's new state and obtain appropriate authorization before continuing (Correct answer)
- Require the client to return physically to the original state for all sessions
- Transfer the case immediately to a counselor licensed in the new state without transition planning
Correct answer: Research licensure requirements in the client's new state and obtain appropriate authorization before continuing
Practicing across state lines requires compliance with the destination state's licensure laws; the counselor must determine requirements before continuing services.
NCMHCE Professional Practice and Ethics 5
A counselor accepts a client's offer of a homemade gift worth approximately $10 at the end of a successful treatment.
According to the ACA Code, this is: