Confidentiality And Documentation In Clinical Consultation

Feb
28
2011

I received an email from J. Kipp Lanning, LIMHP of AdultSpan Counseling in Nebraska asking about peer consultation groups.  He says:Image of Network

A professional group of which I am a member is working on setting up a peer consultation group (APPT: Association of Private Practice Therapists).  Do you have suggestions on how to make this most effective/beneficial regarding paperwork that demonstrates consultation with peers?  Of particular concern to the group is a confidentiality agreement for the group and paperwork for the file demonstrating consultation with peers.

Thanks, Kipp

PS – love your blog!”

Thanks, Kipp, for being part of our online community here at Private Practice from the Inside Out and dropping in to chat!

Confidentiality

I am not an attorney and not qualified to give legal advice.   However, here is some of the information that I have been given related to this issue.  According to mental health attorney, Denis K. Lane,

The generally accepted standard, established by ethical codes and practices nationwide, is that clinical supervision is a confidential process, the same as the counseling done by a supervisee with a client.  Some states have exceptions to this rule, established by their state licensing board rules, but in general the supervision process is as confidential as mental health treatment itself . . . .  Because consultations are a form of supervision according to the Licensing Boards’ Supervision Rule, they, too are confidential.”  (The Legal Guide for Practicing Psychotherapy in Colorado, 2010 Edition, pp. 190-191)

I understand the mandated exceptions to confidentiality to be the same ones that pertain to counseling – those related to the potential for self-harm or the harm of others, court orders requiring disclosure, etc. Because Denis Lane is an attorney practicing in the state of Colorado, I would encourage you to take a moment to check with a mental health attorney in your own state to insure that you, your colleagues, and your clients are fully protected.

Permission from Your Client

You will also want to remember that in order to discuss any client, you must first have that client’s written permission to do so.  Former attorney and now counselor-in-training, Michelle Stevens of Introspection Counseling, offers this language to include in your consent to treatment and disclosure statement:

There may be times when I, as your psychotherapist, may need to consult with my supervisor or with a colleague or another professional, such as an attorney, concerning issues raised by you in therapy. Confidentiality is not waived during these consultations. By signing this disclosure statement, you give me permission, as your psychotherapist, to consult with other professionals as needed to provide professional services to you. This permission may be revoked at any time.”

Obviously, if you are not working under supervision, you do not need to include any reference to a supervisor in your statement

[Michelle is quick to note that the language above "is not intended as legal advice. I am not a practicing attorney and have never been licensed in or practiced in Colorado. When in doubt you should always consult an attorney with the expertise appropriate to your issue."]

Clinical Documentation

The only other paperwork that comes to mind is the documentation that you need to include in your clinical note.  I wrote about that here in The 5 W’s of Clinical Consultation.

Kipp, I hope you’ll drop back in and let us know how your new consultation group fares!  We can all  learn from your challenges and your successes!  I look forward to hearing from you!

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First Things First: Office Policies For Your Consideration

Feb
14
2011

I mentioned in a previous post that one Image of Business Man Depressed by Paperworof the things you can do when you don’t yet have all the clients that you want is to get your office policies in order.  What I meant to say is . . . whatever you do . . . don’t think of waiting until your first client walks in the door to begin thinking about your office policies and procedures. Do it now!

Here’s a few things to consider concerning your own policies. . . .

  • Inclement Weather
    • How will clients learn about office closures and appointment cancellations during bad weather?
  • Client – Therapist Relationship
    • What, if any, gifts will you accept from clients?
    • How will you handle running into clients at social events or in public?
    • What, if any, and where is client-initiated contact permitted between sessions?
    • What do you want to say about dual relationships?
  • Plans for Your Own Incapacity or Death
  • Record Management

Remember, your regulating bodies, state and national laws, and your professional organizations’ codes of ethics will impact all of your office policies.  Once you get them hammered out, you need to decide how you want to present this information to your clients.  (I choose to include them as part of my disclosure statement.You may choose to present it this way or as an entirely different document.)

I’m thinking that this is a good list to get you started. Are there other things that you think should be included here?  If so, leave me a comment to let me know!

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Muffins And Cameras And Artwork – Oh, My! When Clients Bring You Gifts

Oct
4
2010

Over the last 20 years, I’ve had clients offer a variety of gifts . . . a bottle of wine, Christmas ornaments, their own artwork, frequent flier points on airlines, a digital camera, tickets to community events, a muffin from the local bakery, homemade cakes, and books.  Early in my career, I was oftenImage of Gift Box caught off guard.  I didn’t know how to clinically or legally deal with these situations.  For the longest time, I only knew I wasn’t supposed to accept gifts from clients.  But no one told me how (or when) I was supposed to refuse them.

Ofer Zur has published a terrific article called Gifts in Psychotherapy that addresses this very issue.  Do yourself and your clients a favor.  Take time to read and digest this meaty article.  Then, I hope you will check back in here and let me know one thing that you learned or needed to be reminded from reading the article.


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6 Ways To Keep In Touch With Clients

Sep
30
2010

On Monday,  I reminded you that when considering ways to keep in touch with your clients, it’s critical that you consider the legal and ethical implications.  Assuming you’ve taken those into consideration, believe that it is in yourImage of 6 Numbers client’s best interest for you to keep in touch, and have his or her permission to do so, here are six ways that you may be able to ethically, professionally, and effectively accomplish that . . . .

  1. Send holiday and birthday greetings.
  2. Send monthly newsletters.
  3. Send quarterly practice “updates” noting any new training you have achieved, colleagues that have joined your practice, or changes in the hours that you are seeing clients.
  4. Send supplementary information that you may run across relevant to a particular client’s interests.
  5. Send information about new support groups in your community.
  6. Send thank-you notes for referrals.

In other words, look for ethical, legal, and professional opportunities to stay connected to your clients throughout the year.

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Before You Decide To Keep In Touch With Your Clients

Sep
27
2010

Pamela Baker, in Pennsylvania wrote in asking,Image of Before Button “What is the best way to keep in touch with clients?”

While it is a common business practice to keep in touch with clients during and after conducting business with them, it is not always considered legal, ethical, or within the common standards of practice for mental health professionals to do so.  Before you even consider the potential benefits to you and your clients, you must first consider the potential damage that your client may incur from your attempt(s) to maintain contact.

Here’s some examples of potential harm:

  • Are you fostering your client’s emotional dependence on you?
  • Are you unknowingly undermining her independence?
  • If you call your client’s home and her jealous and historically violent partner answers the phone, how do you explain who you are and why you are calling?
  • Does it get any better if you leave a voice male and the same partner picks up the message?
  • What changes if you sent a follow up note following her missed appointment if her partner opens her mail . . . or just notices your return address?
  • What if you send a birthday greeting while your client is off on a trip and her neighbor is picking up the mail and notices your return address?

Our relationships with our clients are complicated and our job, above all else, is to not complicate our client’s lives any more than they already are.  Do no harm.

And, I would add “Do no harm to yourself, either.“  With the recent changes in ethical codes of conduct for mental health professionals, I’ve seen far too many therapists want to slip into dual relationships with their clients or their ex-clients that seem, at least to the therapists,  to be “no big deal.”

However, that has not been my experience.  In fact, every friend and family member that I’ve ever had who has ever seen a therapist and then ended up in a personal relationship with their therapist after termination has indicated the same thing.  The power dynamics in the relationship are always lopsided and the ex-client is always the one  lacking the power.

I tell you this because as therapists we often think we are the exceptions to the rules; and, because we care about our clients we often think that we have our clients’  best interests at heart.  Every week I speak with colleagues and supervisees who say something to the effect of  “I would never make a decision that would negatively impact my client” and yet we do . . . far too often.

Does that mean that you should never keep in touch with your clients?  No.  What it does mean is that you need to do so after careful consideration, consultation,  and only after obtaining fully informed consent from your client.  In my next post, I’ll suggest some ways that you may want to stay in touch.

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