This familiar question asks for a singular answer. That may be important as a clinical or legal question, and it is sometimes required as a reimbursement question. But as an ethical question, it is misleading and problematic. It is important for you (and for those you supervise) to understand why a better ethical question is: “What are my ethical obligations to each of the parties in this case?”
Implications of How We Conceptualize Cases & Define Ethical Responsibilities
I. Who Is The Client?
On asking this as a clinical, legal, or reimbursement question
On NOT asking this as an ethical question
II. ALTERNATIVE QUESTION:
“What Are My Ethical Responsibilities to Each of The Parties in This Case?”
III. Clarifying Responsibilities in Different Types of Cases
A. General Questions
What service(s) will be provided? Who is expected to directly benefit from the service(s)?
Who requested the services? Who will pay for the service(s)?
Will an agency be involved? Are you an employee? If not, do you have a contract?
Who will receive the primary service(s)? Will anyone else receive related service(s)?
Will “collaterals” assist in providing the service(s)? What are their expectations v. your rules?
Who has a right to confidentiality? Who will receive information generated by the services?
Who holds or waives the privilege (in the event of a court case)?
Who has the right to be informed about the above?
B. Individual Therapy
Is a person in individual therapy always “the client”? always the only client?
Can an individual who is the focus of intervention, but never seen, still be “the client”?
If others participate (jointly or alone) do they also become “clients”?
C. Multiple-Client Therapy
Does Multi-Client Therapy differ From “Individual Therapy With Collaterals”
Ethically? Legally? Clinically?
Who gets to decide? Who must you tell? What do you say to third party payers?
D. Child/Adolescent Therapy
Are parents actively involved? If so, are they also “clients”?
What are the rules about disclosure of information to parents/others?
Who gets to decide? What will you explain? To whom must you explain?
IV. How Do Third-Party Referrals/Contracts Affect “Client” Status?
Employee Contracts (Must you accept your employer’s definitions of “client” ? )
Managed Care Contracts (Do reimbursement contracts affect the ethical definition of “client?)
Creating Personalized Contracts for Clarifying Relationships & Responsibilities
Contracts With Agencies (e.g., DSS, Court, Schools, Other)
Consultation Contracts (e.g., Corporate Training, Coaching, Employee Assessment)
(a) Explain why “Who is the client?” is not a helpful ethical question.
(b) List some of the general ethical questions that are important to ask about any type of case.
(c) Describe how ethical questions might differ in individual and multi-client cases.
(d) Describe ethical implications of obtaining or not obtaining a contract with each party before providing services.