Introduction of interview : This interview is part of psychology coursework at the University of

Karachi and focuses on ethical and professional issues1 faced by mental-health providers in
Pakistan. Your willingness, time and views on ethical matters in clinical practice are highly
appreciated. All responses will be kept confidential and anonymous. These responses will
contribute to our understanding about ethical issues and challenges faced by clinical providers
in Pakistan.
Demographic :
1. Name:
2. Gender:
3. Academic qualification: Diploma (yes/no) if yes please write the name of the diploma
M. Phil in ____________________
Ph.D. in ________________________
Certified Training in _____________________
4. Province (the province you are currently practice in ):
5. Work Experience as a psychotherapist.
6. Place of practice in last 1-5 years __________
7. Area of practice: ____________________
8. Target population age of practice: _____________________

Kindly respond in detail to given interview questions.

1. Consent and Confidentiality

a. Do you obtain informed consent from your clients as early as possible in a therapeutic
alliance (how long does that usually take)? And when you seek informed consent do
explain the nature and anticipated course of therapeutic service, the fees involved, and
if third parties may be involved in service provided, please elaborate? Do you talk about
the limits of confidentiality (e.g., conditions that may necessitate breaching
confidentiality for safety like reporting to police and legal agencies etc.) with your
clients? Do you provide sufficient opportunity for the client to ask questions and receive
answers?
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b. What is the mode of obtaining informed consent (verbal recording, written, electronic
etc.)? Do you inform your clients about the developing nature of the treatment, the
potential risks involved, alternative treatments that may be available, and the voluntary
nature of their participation?
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c. If a trainee or an intern works with you and they are part of the clinical service and
legally responsible for the treatment of the client, do you provide information about the
trainee (like they are under your training and supervision, work in your office, and
handle office stationery and client data etc.) to the client at the time of consent taking?
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d. When you provide services to several persons (group sessions or group therapy) do you
take reasonable steps to identify who is your client and who are others (such as spouses,
parents and children or significant others)? Do you clarify your role and relationship with
others, and their probable uses in the services provided or the information obtained,
please elaborate? Do you let them know all information (verbal or recorded) in the
service remains confidential? In some cases, you may require getting consent from
others also, in such cases how do you take consent, please elaborate?
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e. When you provide services to clients who are already receiving mental health services
elsewhere, or from other psychologists what steps do you take to clarify your
involvement with the client and other health providers or services? What kind of
treatment issues do you address and how do you address the welfare of the client?
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f. When you are in a therapeutic alliance with a client, do you believe it is appropriate to
physically touch or greet (e.g., tap on the shoulder or head, shaking hands, or clasping) a
client in a non-erotic way? Are physical contact or greetings with female clients as
 appropriate as male clients? Do you believe physical touch or greeting rituals are
common in Pakistani clinical practice? How do you set your boundaries about physical
touch?
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2. Record Keeping and Fees

a. How do keep and maintain your records and documents?

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b. How do you disseminate (to other professionals, professional conferences, papers etc.)
and dispose your confidential records of your clients? How is confidential information
concerning recipients of psychological services entered into databases or systems of
records available to persons whose access has not been consented to by the recipient?
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c. Do you withhold records for non-payments of service fees? Under what conditions
records are available to others even if payments have not been made?
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d. If a family member pays for client’s therapy and asks you to share information about the
client, how do you respond? In case, you are threatened by the family member (if you
refuse to provide information) how do you deal in such situations?
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e. If a client requests their records, what do you typically do? Under which conditions this
information is not given to the client?
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f. If a school counselor, healthcare professional, or a government official seeks record on a

client what information do you provide which information is withheld?
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g. Are fee practices consistent with provincial and federal laws (e.g., income taxes and fee
receipts etc.)?
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h. When you receive a payment from other counselors or clinicians or divide payments
among yourselves, how does that follow, who leads distribution of divided payments,
please elaborate?
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i. Do you accept barter (carpentry, tailoring or cleaning etc.) for your services in lieu of
payment? How do you estimate barter work in monetary terms? Do you believe
bartering can be exploitative and unethical? If so, how?
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j. How do you handle gifts and offerings from clients on occasions like Eid, concluding
sessions, Eid or other religious or cultural events when gifts could be offered? Do you
have guidelines on accepting gifts and offerings?
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3. After-Service Contact

a. Do you customarily accept making contact (calls, emails, or meeting physically etc.) with
client outside sessions? Would you respond to a client in an emergency condition like,
possibility of a suicidal attempt? Do you specify boundaries for contact outside sessions,
including emergencies before therapy begins?
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b. Do you allow client to contact (calls, emails, or meeting physically etc.) you after clinical
service concludes? If so, how do you handle post-service client-provider relationships,
how do you set expectations and boundaries?
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c. If a client reports sexual misconduct by another therapist who is your colleague, how do
you investigate and report this incident to legal and other authorities about a
misconduct? How do you protect your client?
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4. Termination of clinical Services

a. When do you think a clinical service is complete, is it based on standard duration of

therapy, an estimation on client’s better mental-health, or other, please elaborate?
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b. Do you terminate services if the client rejects therapy, or do you continue the therapy
because you know patient reactions (like transference) will go away after some time? If
you decide to stop intervention at client’s request, do you suggest other therapeutic
options, other mental health professionals or services?
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c. If an involved family member complains, there are no visible change in the mental
health of their client and want to terminate therapy, what do you typically do?
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5. Competence and Professional Development

a. How do you enrich your competency in your services? Reflect on areas which are strong
and up-to-date, and areas that need further enhancements?
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b. Do you believe self-assessment of competence is useful and worthwhile? If not, why

not?
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Thank you for your time and insights today. If you have questions, suggestions or comments,
please feel free to share them with us. Best regards.
Ziasma Khan
Email: ziasmakhan8@[Link]