Writing and publishing can help you establish credibility, build your professional reputation, and position you as one who makes lasting contributions to your profession. All of these can, in turn, contribute to your success in private practice.
Whether you are still in graduate school or you are already hard at work out in the professional world, if you are in need of online tools to help you format your works in APA style, here are some resources for you:
Everything you do for your client matters. If and how you choose to diagnose your client matters a lot. Amanda B. wrote in asking if it is OK to routinely give a diagnosis of Adjustment Disorder to her clients if they do not exhibit symptoms warranting a more serious diagnosis. (She was trying to help them get reimbursed by their health insurance companies.)
The short answer is “No it’s not.” As tempting as it may be to slap an Adjustment Disorder diagnosis on to every client who is dealing with normal life transitions, it’s not wise and it’s not OK — clinically, ethically, or legally.
"Worried Woman" by HikingArtist.com / Frits Ahlefeldt-Laurvig
The clinical implication is this . . . by intentionally giving your client the wrong diagnosis, in this case a more serious diagnosis than is truly warranted, you pathologize your client. This is like going to your primary care doctor for a mosquito bite and him diagnosing you with an infection. Mosquito bites happen just like life happens. Misdiagnosing does nothing to empower your client. Nor does it inform her about the real nature of what’s going on or lead her toward useful strategies for managing the transition at hand.
Ethically you’ve failed . . . to provide honest, accurate and useful information to your client if you’ve told her she has something different than what is true. You’ve also set yourself up to provide inaccurate information to others i.e. physicians, lawyers, etch. that may gain access to your records later on.
And, legally, you’re setting yourself up for big trouble. When you choose to list an inaccurate diagnosis on health insurance claims forms and submit them, you have just committed insurance fraud. Should you choose to put the inaccurate diagnosis into your clinical record, you have falsified documents and failed to meet the professional standard of care.
If knowing all of this you are still tempted (perhaps you believe with good intentions) to misdiagnose a client, seek clinical, ethical, and legal consultation.
[Update 10 Dec. 2009 5:54 pm - Of course, mental health professionals are not the only one fudging on diagnoses. Check out The Last Psychiatrist blog post, "How Am I Going To Get Paid If It Isn't Autism?"]
If your post-graduate supervision is not all that you had hoped for, there may be a really good reason. Do you know that clinical supervision is different from administrative supervision?
An administrative supervisor typically operates from a business model rather than a clinical model. His priority is to make sure that the organization (or her department) runs smoothly. There are local, state, and federal regulations (like the EEOC guidelines and the Disability Act) that impact his decisions concerning her supervision of you.
Administrative supervisors are often
"In Which Zac Never Realized . . . " by Zac Peckler
what you encounter as a new graduate entering the workforce through an agency, hospital, or school setting. You will recognize an administrative supervisor because he will emphasize paperwork and productivity, managing your caseloads, scheduling, and accountability.
An administrative supervisor must train employees to systematically complete basic paperwork, manage crises, work within systems, and deal with large numbers of clients needing many different things at the same time. There is much to be learned from an administrative supervisor that will serve you well throughout your career but this is NOT clinical supervision.
If you are frustrated with the quality of the supervision you are receiving, perhaps you assumed that the supervision you would be receiving from your supervisor would be clinical supervision rather than administrative supervision. Here are some things that you can do to insure that your experience under supervision is all that you want it to be.
When you decide to seek clinical consultation, there are 5 things that you should document in your clinical notes. They are the 5 W’s:
When you seek consultation;
Why you are seeking consultation and why now;
Who you are seeking consultation from;
What opinions / information / recommendations you are receiving from that person even if they contradict your own clinical judgment;
What your final professional opinion / plan is and why you are / are not going to go along with the recommendations received.
"Questions" by Tim O'Brien / Oberazzi
In other words, your clinical rationale all along the way needs to be documented in your notes. Why? To protect both you and your client.
Should you end up in a malpractice suit (which is quite possible), your proper documentation will assist you in explaining your thought process concerning your work with your client. Likewise, should anything happen to suddenly prevent you from continuing to work with your client, your general direction of treatment can more likely continue seemlessly because you have taken the time to thoroughly document your clinical rationale and intent.
Tamara G. Suttle, M.Ed., LPC has maintained a private clinical practice since 1991 and founded Private Practice from the Inside Out in 2003. She has spent almost 20 years consulting and teaching marketing strategies to health care professionals like you. You can learn more about her clinical practice at her website.
Email Tamara
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