1. Do not make custody recommendations or get involved with legal aspects of divorce & custody
- One of the most common and, regretfully, frequent board complaints in recent years occurs when therapists make custody recommendations without the qualifications or expertise to do so and without the data to support it.
- Do not write letters regarding custody recommendations or harm assessment in divorce and custody cases unless you qualify as a custody evaluator or a related forensic expert.
- Some attorneys and clients set therapists up by initiating therapy with a hidden agenda of getting a letter that ‘simply’ states something such as:
- “Mary is a good and fit mother.”
- “Johnny seems extremely upset after he spends time with his mother.”
- “Jane is scared of Bruce’s explosive nature.”
- Leave custody recommendations to court-appointed, qualified and certified custody evaluators.
- Do not sign pre-constructed letters from your client’s attorney about your “expert opinion.”
- Consult, Consult and Consult before writing a letter or signing your name to any document related to divorce and/or custody of your client/s.
- When in doubt, consult.
2. Be extra careful with boundaries with Borderline Personality disordered clients.
* In my forensic practice, I have encountered the most intriguing cases where BPD clients have gotten their therapists to give them money, adopt them, move in with them, do drugs with them, and … have sex with them.
- As a famous CA attorney accurately warned psychotherapists many years ago: “You are one borderline away from losing your license”. He was reflecting on the high % of board complaints and civil law suits initiated by BDP clients.
- Watch out for a dangerous cognitive trap often encountered with BDP clients: “If I only agree with this last demand he/she will settle in, let go, calm down, or finally realize that I do care.” Trying endlessly to appease or avoid the rage of BDP clients is how therapists end up violating boundaries.
- Consult with peers and experts.
3. Pay attention to issues of privacy and confidentiality when it comes to online communications, including FaceBook, or responding to online negative reviews on Yelp.
- Some of the fastest growing areas of ethical and legal challenges involve confidentiality and privacy issues, including when clients and therapists engage in confidential conversations on FaceBook, LinkedIn, Twitter and other social media.
- A similar area of concern is when therapists impulsively-emotionally respond to a client’s online negative review on review sites, such as Yelp.comor Angie’s List.
- Therapists often respond with shock, dread, disbelief and an understandable fear for the future of their reputation, practice and economic future.
- The fact that clients acknowledge that they are psychotherapy clients does not give therapists automatic permission to discuss confidential-clinical information in public or online.
4. Have in place the necessary clinical forms and treatment records
- Have clients read and sign, at the onset of treatment, the Informed Consent to Treatment form where basic confidentiality and limits to confidentiality, fees, termination, missed sessions, etc. are articulated.
- When it applies, have the HIPAA Notice of Privacy Practices, Authorization to Release Information and other relevant forms in the clients’ files.
- Have a basic Treatment Plan outlining the presenting problem, goals of therapy, means/techniques/orientations, etc.
- In many situations, not having some of the above-mentioned forms in the clients’ files constitutes substandard care.
5. Make sure that your malpractice insurance includes coverage for board investigations
- For as little as $40-$50 a year you can get coverage for board investigation with your malpractice insurance, which will help you deal with the board without breaking the bank.
- APA Insurance Trust (APAIT), American Profession Agency, CPH & Associates, and other carriers offer such coverage.
- This is very important because such coverage enables you to effectively respond to board investigations and defend yourself without the out-of-pocket expense of attorney fees.
- Most malpractice insurance companies want you to contact them as soon as you get involved in any legal proceedings.
6. Consulting with experts on difficult cases
- You can do a lot of damage control and reduce risk by consulting with experts prior to learning about a board investigation.
- Consult on complex issues, such as large gifts, complicated avoidable or unavoidable dual relationships, online harassment, complicated termination, complex fees or bartering arrangements, highly demanding, erratic and intrusive BPD or other patients.
- Consult with experts about your treatment plan, record keeping, and other clinical and ethical issues in complex clinical/ethical cases so you are on solid ground if the board does knock on your door or if a civil suit is filed against you.
7. The Obvious: Never have sex with your clients, and never drink and drive.
- Sexual misconducts are some of the most common reasons for therapists to lose their licenses.
- Sexual attraction to clients is common.
- Seek consultation if you are intensely sexually attracted to your clients, your attraction interferes with treatment, or you consider having sexual relationships with your current or former patients.
