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Legal and Ethical Dimensions for Mental Health Professionals
Reviewed by ALAN B. KORBETT, D.O.
Am J Psychiatry 2000;157:1534-a-1535. doi:10.1176/appi.ajp.157.9.1534-a
View Author and Article Information
Snellville, Ga.

by Patrick B. Malley, Ph.D., and Eileen Petty Reilly (Eileen Petty Deklewa). Philadelphia, Accelerated Development (Taylor & Francis Group), 1999, 340 pp., $29.95 (paper).

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The authors of this book identify their goal as to familiarize the reader with and create an understanding of the professional, legal, and ethical obligations of counselors, social workers, and psychologists. They have undertaken a Herculean task in a well-developed and logically orchestrated text. The central themes are the laws that are relevant to mental health professionals and the standards of responsibilities to which they are professionally held.

The authors arrange the text into six parts consisting of 12 chapters to provide a clear course though the legal labyrinth. Part 1, Historical and Helping Perspectives, includes chapters 1 and 2. Chapter 1 provides the text’s foundation of mental health’s historical roots based on historical perspectives, hypotheses, and theoretical orientations of clinical and counseling psychologists. In chapter 2, the authors advance the qualities and skills that the mental health professional brings to "the helping relationship," the cornerstone of the therapeutic intervention.

Part 2, Ethical and Legal Dimensions, is composed of chapters 3 and 4. Chapter 3 explores the tenets of ethical principles such as autonomy, justice, nonmaleficence, and fidelity. Examples of modern ethical theorists are provided, and Kohlberg and Gilligan are cited to convey a framework for client-therapist relationships. To punctuate the complexity of these issues, a brief discussion of ethical virtues, a controversial element of counseling that focuses on the actor not the act, is broached. Chapter 4 provides the mental health professional with an overview of the legal domains of constitutional, statutory, and case law. The authors provide a glimpse into the intricacies of civil, criminal, and mental health law and review the procedural steps in the evolution of a lawsuit. The authors also provide insight into practical issues in counseling relationships, such as malpractice, professional policy (advertising, client records, dual relationships, liability insurance), special relationship issues (informed consent, release of information, confidentiality, privileged communication), and issues related to deposition and courtroom witnessing.

Part 3, Multicultural Context, is addressed in chapter 5, which discusses the challenges posed for mental health professionals by the changing demographics of the United States and the impact of culturally diverse clients. A critical assessment of the psychological theories and research practices of Western versus non-Western psychological structures is offered. The need for mental health professionals to acquire and develop the skills of to be responsive to cultural changes is a central issue.

Part 4, Relationships With Special Populations, includes chapters 6, 7, and 8. Chapter 6 addresses issues of training, ethical/legal mandates, and characteristics of potentially suicidal clients. The authors provide suggestions for interventions and strategies for the general population as well as particular populations. Readers are introduced to the numerous ethical and legal dilemmas therapists face (Tarasoff, the client with HIV, and AIDS). Chapter 7 acquaints the reader with the issues of child abuse (physical, sexual, and emotional), the role of mandatory reporters, and specific issues pertaining to the assessment of sexual abuse and how to counsel the victims. Pertinent issues related to the gay and lesbian client are discussed. Chapter 8 addresses a multitude of "special relations" the therapist may enter into with "special clients" (minors, as a consultant, in the managed care setting, substance-abusing clients) and the complexities of such relationships.

Part 5, Considerations in Schools, Groups, Marriages, and Families, includes chapters 9, 10, and 11. Each chapter addresses specific elements and issues unique to each setting. The authors note that because of the ethical and legal implications of the many issues relevant to these settings, recognition of the competency and expertise of the counselor is at a critical juncture.

Part 6, Considerations in Training, is composed of one closing chapter, which focuses on the strides taken and more directly the shortcomings of mental health professional training programs. Issues of training, supervision, credentialing, and the problematic dual relationships of supervisor and trainee are noted. The aforementioned is not a condemnation but a constructive criticism. The final summary proposes recommendations for improvement of training of mental health professionals.

The authors’ educational objectives are reinforced by the structure of the text. Each chapter concludes in a summary followed by a learning facilitation and focus section. This section provides the reader with the opportunity to recapitulate primary concepts of the chapter and apply them to exercise scenarios, creating a reinforced learning experience.

At the outset of this review, I referred to the breadth and expanse of the topic of legal and ethical issues pertaining to mental health professionals as a Herculean task. The publisher describes Legal and Ethical Dimensions for Mental Health Professionals as a "complete guide" and a "comprehensive look." The adjectives "complete" and "comprehensive" are oxymoronic when applied to a work addressing such vast and complex dimensions. This book masterfully serves as a vehicle that familiarizes the reader with and heightens the reader’s awareness of the complexities of the ethical and legal nuances pertaining to the mental health professional. As such, it accomplishes the authors’ objective and offers a valuable addition to the mental health professional’s library.




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