Consent, Confidentiality, Privilege
16%of exam
Limits and Mandated Reporting
16%of exam
Legal Standards for Practice
12%of exam
Professional Competence and Integrity
16%of exam
Responsibility to Clients
24%of exam
Practice Policies and Responsibilities
16%of exam
Quick Facts
- Exam
- LMFT Law and Ethics
- Board
- California BBS
- Vendor
- Pearson VUE
- Items
- 50 scored, 25 pretest
- Time
- 90 minutes
- Fee
- $75 until June 2030
- Score report
- Pass or fail only
- Retake wait
- 90 days
- Eligibility
- AMFT registration
- Blueprint
- Effective January 2024
Records Clocks
Inspect 5 days, copies 15 days
Inspection: 5 working daysCopies: within 15 daysBoard request: 15 daysRetention: seven years
Confidentiality vs Privilege
Confidentiality
- Therapist duty
- Applies in practice
- Broken by legal exceptions
Privilege
- Evidence rule
- Applies in legal proceedings
- Client holds it
Practice duty vs court rule
Records Request Picker
- Client wants to read→Allow inspection, 5 workdays
- Client wants copies→Send within 15 days
- Release risks harm→Offer designated professional review
- Subpoena arrives→Assert privilege, notify client
- Court order arrives→Comply with the order
- Parent of minor asks→Check detriment exception
- Board requests records→Provide within 15 days
Consent and Disclosure
- Client notice
- BBS complaint notice required
- Notice format
- At least 12-point type
- Notice contents
- Name, number, type, expiration
- Notice proof
- Delivery must be documented
- Fee disclosure
- Before treatment begins4982(n)
- Good faith estimate
- Self-pay clients
- Associate disclosure
- Unlicensed status, number, employer
Subpoena vs Court Order
Subpoena
- Assert privilege
- Do not release
- Notify client
Court order
- Judge decided
- Comply as ordered
- Release named records
Assert vs comply
Privilege Essentials
- Evidence Code 1010
- Defines psychotherapist
- Evidence Code 1011
- Defines patient
- Evidence Code 1012
- Confidential communication defined
- Evidence Code 1013
- Names the holder
- Evidence Code 1014
- Right to refuse disclosure
- Evidence Code 1015
- Therapist must claim privilege
- Holder
- Client, guardian, or representative
Privilege Exceptions
- Evidence Code 1016
- Client raises mental condition
- Evidence Code 1017
- Court-appointed evaluation
- Evidence Code 1018
- Services aided crime
- Evidence Code 1023
- Competency proceeding
- Evidence Code 1024
- Danger to self or others
- Evidence Code 1026
- Information required to be reported
- Evidence Code 1027
- Child victim under 16
Records Access Clocks
- Inspection
- Within 5 working days
- Copies
- Within 15 days
- Access law
- Health and Safety 123110
- Refusal ground
- Substantial risk of harm
- After refusal
- Note reason, inform client
- Alternative
- Designated licensed professional inspects
- Board request
- Copies within 15 days
Minor Consent Rules
- Family Code 6924
- Minor outpatient consent
- Minimum age
- 12 years or older
- Standard
- Mature enough to participate
- Parents
- Involve unless inappropriate
- Documentation
- Record contact attempt outcome
- Payment
- Parents liable only if participating
- Limits
- No psychotropics or convulsive therapy
Reporting Clocks
Child 36 hours, elder two days
Child: phone immediatelyChild: written 36 hoursElder: phone or internetElder: written two days
Child vs Elder Reporting
Child abuse
- Phone immediately
- Written 36 hours
- Penal Code 11166
Elder abuse
- Phone or internet
- Written two working days
- WIC section 15630
36 hours vs two days
Reporting Picker
- Suspect child abuse→Phone report immediately(Written 36 hours)
- Suspect elder abuse→Phone or internet report(Written two days)
- Dependent adult abuse→Same elder abuse process
- Facility abuse, injury→Verbal within two hours
- Serious threat stated→Warn victim and police(Civil Code 43.92)
- Client gravely disabled→Refer for 5150 evaluation
- Prior therapist sex→Give required brochure(BPC 728)
Child Abuse Reporting
- Trigger
- Knows or reasonably suspects
- Standard
- Objectively reasonable suspicion
- First step
- Phone immediately or ASAP
- Written report
- Within 36 hours
- Form
- DOJ-adopted report form
- Law
- Penal Code 11166
- Failure to report
- Unprofessional conduct
Tarasoff Trigger
Communicated threat, identifiable victim, then warn
Threat told to therapistVictim reasonably identifiableWarn the victimNotify law enforcement
Duty to Protect vs Warning
Trigger
- Communicated serious threat
- Identifiable victim
- Duty then arises
Discharge
- Warn the victim
- Notify law enforcement
- Liability protection follows
Threat triggers, warning discharges
Elder and Dependent Abuse
- Law
- Welfare Institutions Code 15630
- First step
- Phone or internet tool
- Timing
- Immediately or as practicable
- Written report
- Within two working days
- Covered harms
- Physical abuse, neglect, isolation
- Facility abuse
- Verbal within two hours
- Facility written
- Within 24 hours
Danger and Crisis Duties
- Civil Code 43.92
- Duty to protect
- Trigger
- Communicated serious violent threat
- Victim
- Reasonably identifiable person
- Discharge
- Tell victim and police
- Immunity
- No liability once discharged
- Grave disability
- Cannot meet basic needs
- 5150 hold
- Up to 72 hours
- Who may hold
- County-designated professionals only
Blueprint Split
Law 44 percent, Ethics 56 percent
Consent 16%Reporting 16%Legal standards 12%Competence 16%Client duties 24%Policies 16%
Trainee vs Associate
Trainee
- Still in degree program
- No registration number
- 12 units completed
Associate
- Degree awarded
- Registered with board
- Number appears in ads
In school vs registered
Records Retention and Disposal
- Adult records
- Seven years after termination
- Minor records
- Seven years after turning 18
- Format
- Written or electronic
- Disposal
- Protect confidentiality when destroying
- Law
- BPC 4980.49
- Content standard
- Sound clinical judgment
Licensee CE vs Associate CE
Licensee
- 36 hours
- Every two years
- Renewal requirement
Associate
- Three hours
- Law and ethics only
- Every year
36 biennial vs three annual
Unprofessional Conduct
- Sexual relations
- Barred two years after termination
- Fees
- Undisclosed fees are violations
- Referral fees
- Paying or accepting prohibited
- Advertising
- No false or misleading claims
- Competence
- No practice beyond competence
- Confidentiality
- Failure to maintain is violation
- Conviction report
- Tell board within 30 days
- Records to board
- Within 15 days
Associate Registration Rules
- Registration term
- Expires after one year
- Exam duty
- Take yearly until passed
- Renewals
- Maximum five renewals
- Hard limit
- Six years total
- Subsequent number
- Requires passing the exam
- Associate CE
- Three law and ethics hours
- Licensee CE
- 36 hours every two years
Competence and Impairment
- Scope of competence
- Education, training, experience
- Staying current
- Track professional developments
- Cultural competence
- Diversity-informed services
- Beyond competence
- Refer or gain training
- Impairment
- Stop practice, seek help
- Substances
- No practice while impaired
Values and Objectivity
- Self-awareness
- Monitor personal values
- Bias
- Prevent effects on treatment
- Conflicts of interest
- Avoid client exploitation
- Consultation
- Seek help early
- Documentation
- Record consultation decisions
Board Discipline vs Crime
BPC 4982
- Unprofessional conduct
- Board discipline
- Two-year former-client bar
BPC 729
- Criminal offense
- Jail or fine
- Sexual exploitation charge
License action vs prosecution
Boundary Picker
- Client offers gift→Discuss impact, then decide
- Client requests friendship→Decline, explain boundaries
- Attraction develops→Seek consultation immediately
- Former client contacts→Two-year bar applies
- Colleague acts unethically→Address per ethical standards
Boundaries and Dual Roles
- Sexual contact
- Prohibited with current clients
- Former clients
- Two-year statutory bar
- BPC 729
- Sexual exploitation is crime
- BPC 728
- Give brochure, discuss it
- Brochure
- Therapy Never Includes Sexual Behavior
- Gifts
- Weigh therapeutic impact first
- Nonprofessional contact
- Avoid exploitive dual roles
Termination and Continuity
- When to terminate
- Treatment no longer needed
- Referral
- Offer qualified alternatives
- Continuity
- Plan interruptions and coverage
- Abandonment
- Avoid abrupt unplanned endings
- Documentation
- Record rationale and referrals
- Autonomy
- Respect client decisions
Experience Math
3,000 hours across 104 weeks minimum
1,700 post-degree minimum1,300 pre-degree maximum1,750 direct clinical500 couples, families, children
Telehealth Steps
- Starting telehealth→Obtain informed consent(BPC 2290.5)
- First session→Give license number
- Before treatment→Explain risks and limits
- Every session→Verify name and location
- Setting up→Note local emergency resources
- Client outside California→Follow that jurisdiction
Telehealth Standards
- Rule
- 16 CCR 1815.5
- Consent
- Obtain per BPC 2290.5
- Disclose
- License number and type
- Risks
- Explain telehealth limitations
- Each session
- Verify name and location
- Emergencies
- Document local crisis resources
- Out of state
- Follow other jurisdiction rules
- Training
- Three telehealth hours required
Supervision Limits
- Total hours
- 3,000 over 104 weeks
- Post-degree
- At least 1,700 hours
- Pre-degree
- No more than 1,300
- Direct clinical
- At least 1,750 hours
- Relational hours
- 500 with couples, families, children
- Weekly supervision
- One hour each credited week
- Weekly cap
- Six supervision hours credited
- Supervisee cap
- Six in nonexempt settings
- Supervisor license
- Two years within five
Advertising and Fees
- Associate ads
- State registered associate status
- Ad details
- Number, employer, supervision
- AMFT abbreviation
- Only with full title
- Trainee ads
- Supervisor designation and number
- Fictitious names
- No misleading business names
- Fee basis
- Disclose before treatment starts
Common Traps
Confidentiality vs privilege
Confidentiality is practice duty ≠ Privilege is courtroom rule
Subpoena vs court order
Subpoena, assert privilege ≠ Court order, release records
Report clock mix-up
Child written 36 hours ≠ Elder written two days
Warn vs protect
Duty is to protect ≠ Warning discharges the duty
Retake course myth
No 12-hour retake course ≠ Associates need three CE hours
National exam myth
California uses its exam ≠ AMFTRB exam not required
Passing score myth
No published cut score ≠ Report shows pass or fail
Trainee vs associate ads
Associates list registration number ≠ Trainees list supervisor details
Last Minute
- 1.Exam: 50 scored, 25 pretest
- 2.90 minutes, no published cut score
- 3.Law 44%, Ethics 56%
- 4.Child abuse: written within 36 hours
- 5.Elder abuse: written within two days
- 6.Tarasoff: warn victim and police
- 7.Records: keep seven years after termination
- 8.Inspect records within 5 working days
- 9.Copies of records within 15 days
- 10.Minors 12 and older may consent
- 11.Sexual relations barred two years
- 12.Associates: three law-ethics CE hours
- 13.Licensees: 36 CE hours biennially
- 14.Subpoena: assert privilege, not release
- 15.Supervision: 3,000 hours, 104 weeks
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