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Controversial and Contemporary 'Hot' Issues & Myths in Psychology

Clinical Update March 2014
By Zur Institute

View a complete list of Clinical Updates.

Controversial Issues Sign Post



Obviously, this is not a complete list. We would like to hear from you via e-mail on what you may consider additional issues that are not included in this piece.


1. Do minor boundary crossings inevitably lead to boundary violations, exploitation and harm? The baseless and paranoid and rather idiotic idea of the "slippery slope" has been with us for too long and, when followed, results in substandard care.
More info: Free Articles, Courses, Book

2. Are dual relationships always unethical and counter-clinical? The myth of the depravity of dual relationships and that all dual relationships are unethical is dying slowly.
More info: New Article, Free Articles, Course

3. Must therapists always give referrals when a client terminates prematurely? Therapists must not always give referrals to clients who terminate against their advice. It all depends on the circumstances.
More info: Guidelines, Online Course, Consultation

4. Is it ever ethical for a therapist to be seen naked by a client? While sex with clients is always wrong, imagine situations where therapists encounter their clients on nudist beaches, in a hot tub at Esalen, or in the local gym's dressing room.
More info on Experiences Outside the Office: Article, Course

5. Are psychotherapists always more powerful than their clients? Unlike the common myth of the 'inherent power differential," some clients are, indeed, vulnerable and less powerful while others may be wealthy-powerful CEOs, established artists, or simply very centered individuals.
More info: Free Article, Course

6. Is it ever ethical for a male therapist to say, "I love you," while stroking the hair of a young female client as she is lying on a bed? Imagine that this exchange takes place in a hospital room, where a young, terminal cancer patient has invited her long time therapist to spend one last visit with her before she dies. The point is: It is all about CONTEXT.
More info: Context in Therapy, Online Course

7. Should clinicians comply with clients' demands for letters stating they are good parents and should have primary custody of their child? The best way to get into trouble with the licensing board is to comply with such requests. Clinicians should NEVER write such letters because they neither conduct child custody evaluations nor are such evaluations within their scope of practice.
More info: Online Course

8. Are risk management and ethics the same? Unlike what many ethics workshops teach us, risk management is NOT the same as the codes of ethics or the standard of care.
More info: Free Article, Online Course, Consultation

9. Is the standard of care fixed, constant and static over time? Generally, as more therapists practice in a new way, this new way gradually becomes part of the standard of care. For example, telehealth is becoming part of the standard of care in the 21st century.
More info: Free Article, Course, Consultation

10. Is it ever permissible for a mental health practitioner to physically assault or even shoot a client? Generally, therapists have the right to defend themselves from physical assaults on themselves or on other patients or staff. This was the unusual case in PA in 2014 where a psychiatrist killed a patient who was shooting at him and others in a mental hospital.
More info: Details on PA shooting, More info on Dangerous Clients, Consultation

10. California's new 2014 law, AB1775, is very controversial as it requires psychotherapists and counselors to report if a patient has knowingly downloaded, streamed, or even simply accessed (that is, viewed) an electronic or digital image in which anyone under 18 "is engaged in an act of obscene sexual conduct." That's any image that lacks "scientific, literary, artistic, or political" value. This recent 'politically correct' change to California's legal definition of "sexual exploitation of a minor", according to many experts, has created a new set of problems for therapists who must report such actions by their clients, while making therapy more dangerous for many patients - without any increase to public safety.
More info: Critique of AB1775

Digital Ethics & TeleMental Health

11. Is f2f superior to phone or online therapy? Unlike the common belief, there is no evidence that face-to-face therapy is superior to online therapy.
More info: Online Course

12. TeleMental Health is here to stay? Whether we like it or not, technology is here to stay. Undeniably, the 21st century will see huge increases in TeleMental health. Therapists who want to stay in business must learn about telehealth.
More info: Resources, Online Courses

13. Can I use my standard un-secured e-mail and texting programs with clients? Therapists can use un-secure e-mails and texts as long as they have informed clients about the potential risks involved and offer clients HIPAA compliant alternatives.
More info: Article, Online Courses

14. Can I provide tele-mental-health services across state lines? Generally, you can treat clients who reside in the state where you are licensed. Then it can be more complicated.
More info: Article, Online Course

15. Is it ethical to have clients as Facebook friends? It depends if it is a FB personal profile or therapist's professional FB Pages and what is on the therapist's profile, the personalities, ages, presenting issues and background of the client, the nature of the therapist-client relationship and much more.
More info: Free Article, Online Course

16. Is using Skype Kosher? As Skype is so convenient, popular, free and easy to use, many therapists have been using it to conduct online therapy and supervision. However, Skype is not HIPAA compliant, as it neither gives a BAA, nor does it notify therapists when breaches occur. VSee seems to provide a BAA to solo mental health practices at a reduced cost. You will need to inquire with VSee to find out the price and other details. You can also find an extensive comprehensive of options, with side-by-side comparisons, at
More info: Resources, TeleMental Health & Digital Ethics Certificate

17. Is it a good idea for therapists to text with clients? Using texts with clients in 2014 is becoming an obvious must, as an increasing number of clients (primarily young ones) neither check their e-mails nor their phone messages.
More info: Office Policies, Online Course on Digital Ethics

18. Is it OK to sign your e-mail with "Love John" or "XOXO"? Signing an e-mail with "Love xx" or with "xoxo" has become common and standard e-language. The standard of care is evolving and is context-based.
More info: Online Course on Standard of Care

19. Is it OK to ask clients or colleagues for testimonials to post online? Generally, soliciting testimonials from clients is not 'ethical' but is OK from colleagues and supervisors.
More info: Online Course

20. Do therapists need to respond to clients' e-mails and texts instantly? No! Therapists neither need to be available 24/7 nor respond instantly. That should be spelled out in the initial Informed Consent.
More info: Online Certificate

21. Should we keep records of e-mails and texts? Significant e-mails can simply stay on therapists' computers/servers and significant texts can be copied, transcribed or described (like voicemail messages).
More info: Article, Online Course, Consultation

22. How can therapists counter negative postings about them on Yelp? Do not respond impulsively, it can get you in trouble. Get informed and consult.
Online Course, Consultation


23. HIPAA, in 2014, is not what it used to be. Following are some of the more important issues to consider (or re-consider) and helpful resources:

  • 23a: Who is a Business Associate and when do you need a contract?
  • 23b: Are you a Covered Entity and what does it mean if you are not?
  • 23c: Are you set with your Self-Assessment, as it is becoming an increasingly important mandate?
  • 23d: Can you identify a breach and do you know about the Breach Notification Rule?
  • 23e: What is HIPAA stance regarding encryption?
  • 23f: Are you aware of the latest update of HITECH & Omnibus Rule?
  • 23g: Do you know how to conduct Risk Assessment?
  • 23h: Do you know about Computer Security and Safe harbor for computers and storage devices?
  • 23i: What is the relationship between HIPAA & the Standard of Care?
  • 23j: What does HIPAA say about Electronic Health Records (EHR)?
  • 23k: What is the conduit exception?
  • 23l: What is HIPAA's take on e-mails, texts, faxes, & voice messages?

These topics and much more are covered in our Online HIPAA Courses - 21 CE Package including HIPAA forms

Clinical Issues

24. Is Harm Reduction a valid alternative to abstinence? Many clinicians uncritically subscribe to the AA notion of, "once an alcoholic, always an alcoholic" even though the fact is that the Harm Reduction model (i.e., controlled drinking) has extensive scientific support and is widely applied in Europe.
More info: Online Course

25. Should therapists 'prescribe' meditation? Research has repeatedly shown that patients who practiced mindful meditation were significantly less depressed, anxious, angry and confused than those who hadn't practiced meditation.
More info: Online Courses Meditation & Mindfullness

26. Is it time to decriminalize drugs and de-pathologize drug use? Think about driving. There are people who dangerously speed, those who drink & drive who have road rage or text. We have ways to help those people, to make our society safer, but we do not resolve the problem by banning driving, like we do with drugs

27. Is it time to stop calling what we do not like or appreciate or can relate to… 'addiction"? Too many clinicians readily label all forms of porn viewing as sex-addiction, intense Facebook or Gaming involvement as Internet-Addiction.
More info: Online Courses: Internet Addiction, Cybersex, Gaming

28. Should psychotherapists stand up for psychopharmacology and psychiatrists who medicate one year old children with psychotropics? 280,000 babies from 0-1 year of age are prescribed psychiatric drugs. 198,000 children 0-5 years old are taking ADHD drugs. 10 million US children are currently being prescribed psychiatric drugs. What do psychotherapists or counselors do in response? Sadly, not much.
More info: Online Course

29. Are "victims" always completely innocent, or do some bear responsibility for their misfortunes? (Transcript) Psychotherapists and attorneys are in the forefront of those who fuel the "Victim Industry" in the U.S. "Don't blame the victim," has become a moratorium on exploring situations where victims bear responsibility. As a result, we have become a nation of victims.
More info: Free Resources, Online Course

30. Do we always need to use a DSM diagnosis in our initial assessment report of treatment plan? While insurance companies and Medicare may require a DSM diagnosis, therapists are not required to include it in their own initial assessment or treatment plan.
More info: Online courses on Treatment Planning, PDM

31. Must we only employ Empirically Supported Treatments? Even though it has been repeatedly argued that CBT and psychopharmacology have been easier to study in short term research, they have not been proven superior to humanistic psych., psychodynamic, mindfulness, life-style (exercise & diet), and other interventions.
More info: Online course Ethical Decision-Making

32. Are women always the victims, or are they also the perpetrators of domestic violence? While it is politically incorrect, the most recent research has shown that women are almost as likely as men to initiate and be involved in domestic violence.
More info: Online course Female Batterers - Male Victims

33. Is the DSM a scientific, valid, and reliable document? Unlike what we were told by experts, the DSM is a politically and economically driven document rather than a scientific one.
More info: Article, Online Course on DSM-5: Diagnosing for Status and Money

34. Is it appropriate to treat more than one member of a couple, concurrently, in individual therapy? While dogmatic family and couple therapists may disagree, every situation is different and treating individual and couple concurrently can be highly effective.
More info: Online Course, Clinical Forms

35. Is an affair always a "symptom" of problems within a marriage? Sometimes extramarital affairs take place as part of a loving, committed marriage. Research has shown they may even enhance marital satisfaction. Not all affairs are created equal and not always indicate a problem with the marital relationship.
More info: Types of Affairs, Online Course

36. Is PTSD really increasing, or are therapists confused about diagnostic criteria? Diagnosis of PTSD has proliferated in recent times causing statistics of the disorder to be inflated due to the fact that therapists confuse clients upset, rage, or disappointments with the DSM diagnostic criteria of experiencing life threatening events.
More info: Audio (Transcript), Online Course (20 CE)

37. Is there such a thing as pediatric bipolar disorder? There must be something seriously wrong with the idea of diagnosing a 2 year old with a bipolar disorder. Pharmacological industry's greed and physicians' compliance (and greed) has no limits.
More info: Free Article, Online Course

38. Is Complementary and Alternative Medicine (CAM) legitimate? CAM has been used for thousands of years. In fact, it has been the main course of treatment for most of human evolution. It generally involves the treatment of mental conditions and mental disorders via nutrition (diet & supplements), exercise, meditation and other mindfulness practices, life-style adjustment, animal assisted therapies, etc.
More info: CAM Online CE Certificate Program

39. Should therapists ask their clients direct and specific questions about sexual practices? Therapists tend to shy away from exploring detailed and probing questions regarding their clients' sex life and as a result often missing huge concerns and unspoken tensions with high clinical significance.
More info: Online Course

Managing and Marketing Private Practice

40. What is your online presence? Online presence is essential these days. At the minimum, this should include a web site, Facebook page & Yelp profile. Blogs, twitter, Google+ can provide additional presence.
More info: Free Article, Online Course

41. Have you Googled yourself lately? It's very important for you to Google yourself regularly to see what prospective and current clients may view about you online.
More info: Online Course

42. Do you have a Google Alert? It's easy to be notified on an ongoing basis about any new web postings that mention your name. Simply sign up at
More info: Online Course

43. Are you informed about the changes introduced by the DSM-5? Get informed on the changes introduced by the new DSM-5, such as doing away with the multiaxial system and revising several diagnostic categories.
More info: Online Course

44. How does Obama Health Care Reform affect you? Get informed about Obama Care and find out if it is relevant to your practice.
More info: Article, Effect on Substance Abuse treatment

45. Are you ready to incorporate TeleMental Health into your practice? Without any shadow of doubt, TeleMental Health will be a significant part of the future of psychotherapy and counseling. Do not get left behind.
More info: TeleMental Health Resources, Online Course

46. Have you been using the new CPT codes when filing insurance claims? Needless to say, using the new-correct CPT codes is essential for insurance reimbursement. For example, the new Code of 90834 is for a 45 min Psychotherapy session.
More info: Article, Online course on Fees

47. Have you been using the new insurance form? Most insurance companies, starting Ap. 1st, 2014, will expect that you use the new CMS-1500 (2/12) claim form when submitting a bill.
More info: Obtain new form

48. Is it ethical to bill insurance companies for clients who miss sessions? No, it is not ok to bill insurance for missed sessions, unless the contract with the insurance company specifically permits it.
More info: Article

49. Can psychotherapists routinely waive insurance co-pays? You must carefully read your insurance contract and make sure you understand what it says about waiving co-pays. If you then decide to waive insurance co-pays, make sure you do not do it routinely with all clients, and document your reasons in the clinical records. Consult with experts on difficult cases.
More info: Free Article, Online Course

50. Is it ethical to routinely code 90791 (initial psychiatric evaluation) for every first session or after the first session? It is generally acceptable to use 90791 for first sessions with clients since it commonly involves history taking and diagnostic assessment. Generally, most insurance companies will pay for only one Initial Evaluation, however sometimes one can get special permission to use multiple 90791s. If you are audited, you may be required to show a complete diagnostic assessment for this first session.
More info: New CPT Info, Navigating the Insurance Maze, Consulting with Ms. Griswold, LMFT

51. Have you been paying attention to your Yelp profile and reviews? Make sure that you have a sold profile on Yelp and regularly monitor your Yelp reviews. If appropriate, get colleagues to write positive reviews.
More info: Online Course

52. How to respond to negative Yelp reviews? It is most important, when you see a negative Yelp review to DO NOTHING! Consult, consult and consult before you do anything so you will not regret it.
More info: Consultation, Online Course

53. Can you solicit clients' testimonials? While you cannot solicit online testimonials from clients, you may from colleagues and supervisors.
More info: Online Course

54. Should you pay extra to your insurance company for licensing board complaints/investigations? Absolutely yes! Most insurance companies offer for an extra $40 or $100 a huge extra coverage, which can help you tremendously in fighting back complaints and investigations by licensing boards. Just do it!
More info: Online Course

55. Are therapists at high-risk for lawsuits? No, we are not! We have been indoctrinated to fear lawsuits. The fact that psychotherapists pay malpractice insurance in the range of $400 to $1,300 a year in comparison to some physicians (e.g., obstetricians and neurosurgeons) who may pay up to $100,000 per year illustrates that we, therapists, are a VERY LOW RISK group. It's still a good idea to have high protection.
More info: Free Article, Online Course

56. Is practicing from home a good option? Many therapists prefer the intimate and private setting of a home office. However, this is not for all therapists and all clients. This option will become more popular with TeleHealth gaining in popularity.
More info: Online Course

57. Are you a businesswoman (businessman) or a clinician? You are both. As a small business owner, you must attend to essential issues of marketing, accounting, liability, etc.
More info: Practice Building Tips

58. What are some of the most important marketing issues? Online presence (warm, personal, professional), giving free presentations to local organizations or writing in the local newsletter on topics relevant to the community, being active in your community, consulting with local headmasters, principles, ministers, fire-chief, business group, etc.
More info: Article

59. What does your marketing plan look like? For each target audience identify how you are going to reach them, estimate costs, and follow up. Then develop your online presence.
More info: Article, Online Marketing

60. What are the biggest obstacles for a fee-for-service practice? The main two reasons that therapists do not succeed in fee-for-service practices are: 1. Most therapists they do not believe that healing and profit mix. 2. They come up with zillions of excuses to justify their failure to build fee-for-service practices (the most common one is "There is not enough money out there"). Psychics, diet industry, hairdresser, porn sites, and cosmetic surgeons do not make excuses, they make billions of $ in profit every year.
More info: Private Practice Handbook, Upcoming seminar

61. Is fee-for-service private practice OUTSIDE managed care truly a viable option? Being in practice over a quarter century and training dozens of thousands of therapists across the country, I have no doubt that fee-for-service private practice is a viable option, more so today in 2014.
More info: BeAWealthyTherapist

62. What are the essential elements of practicing on a fee-for-service basis? Strong online/offline marketing efforts, 'show up' as an 'expert who can help', no apology for charging $200/hr., and much more.
More info: Interview-MP3 (Transcript)

63. Is it ethical to terminate treatment when a client can no longer pay? While, generally, we have no obligation to see clients who cannot or do not pay, we should not 'abandon' them either. Terminations must be handled thoughtfully and with care. Delay termination if the client is in crisis. Give notice and reasonable time for termination to take place. Give referrals if necessary. When appropriate, assist with the transition to a new therapist. Make sure to document well.
More info: Guidelines, Online Course

64. Can therapists accept payment from clients who earn money illegally (i.e., via drugs, prostitution)? Unless the situation includes a danger to the self/client, others, or constitutes child or elder abuse or other 'duty to report' situations, therapists must maintain confidentiality. Ethical, moral and clinical considerations may be factored in and record-keeping must be done with caution. As always, consult in difficult situations.
More info: Online courses on Confidentiality, Ethical Decision-Making, Consultation

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