Question/Answer Corner: What’s On Your Mind?

Q: You receive a call asking for therapy services for a child client. The parent who calls informs you that he/she is considering divorce and wants to make sure his/her child gets into therapy in advance of the split between the parents. You think this is a wise thing for the parent to do – will you take the new child client?

A: It depends upon whether or not you like going to court and just, in general, being involved in divorce and custody litigation, even from the sidelines. While you may admire the parent’s wish to engage the child in therapy prior to the upheaval of the parents’ divorce, you should really ask yourself if you want to get involved. This is – by definition and my experience defending mental health professionals – a HIGH-RISK case. How thick is your skin? Is your liability insurance premium paid? Are you willing to be dragged into an ugly matter (it may not be, but statistically probably will be) and perhaps having to defend a grievance in the worst case scenario?

None of these horrors may come to pass, but when I get this type of call, I say that I would prefer referring the parent to a mental health professional who does not mind court involvement. Then, make sure you find some folks for referrals who really do enjoy this type of litigation involvement. There are some out there and they will welcome the referral. It might just keep you happier this year if you pass along the hot potato. Do not feel guilty about doing so, if that is what you choose.

Remember, clinical practice in this litigious age requires clinicians to be aware and more self-protective than back in the old days (dinosaur age??). So, do what you have to do to keep yourself mentally healthy and emotionally centered for all your clients, your family and friends, and yourself. Managing new referrals to weed out the high-risk variety can help in this process and prevent burnout. Good luck!

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Taking Our Health and Well-Being for Granted?

Recently, I had a new experience, which many of you probably have had or have had something similar: knee surgery. I apparently tore my meniscus – hey, before this event, I didn’t even know what a meniscus was (or how to spell it). But, in training my rescue dog with a million pivots to help her get the idea that when we walk, it is the “loose leash” method, rather than the “tugging me along” method, I believe I ripped the old meniscus. That pivoting, combined with hoisting myself over the baby gate and up and down the deck stairs a million times for the new golden pup to become housebroken, was apparently enough to give my knee a real challenge – one that I lost!

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Some Examples Of Licensing Board Complaints

This section is provided to give you some examples of situations that the Boards are considering and some trouble that licensees have encountered.

(1) Alleged disruption in therapy and abandonment of client – therapist actually was caught between grandmother, who called to schedule child’s appointment, and dad who brought child to session and then never requested a follow up session. But therapist did not return phone calls from grandmother seeking additional appointments, so Board offered Consent Agreement due to perceived abandonment and premature termination. LESSON: always document your attempts to refer clients if they do not return, especially in a case like this where different parties want different things (usually in the context of divorce, right?!).

(2) Facebook posting by a therapist where political comments were made voicing the opinion that if someone had a mental health disorder, he/she should not be in public office. The Complainant took offense and filed a grievance. The Board dismissed the Complaint reasoning that the FB account was the therapist’s personal account and the Complainant was a “friend” on that account, but not personally involved. I am not sure if the Complainant was a client or not. Just heed this warning: Although this matter was dismissed, be careful about how you use social media and do not allow your clients to “friend” you.

(3) Complainant alleged that therapist didn’t respond timely enough to a request for a report for court – but C. only gave 5 days notice for the report and therapist was on vacation so C. got vacation responder via email and didn’t like it, so filed a Complaint. This was dismissed, but beware of relying upon vacation messages – may consider having your emails forwarded while on vacation, especially if a long vacation. Or could have your email vacation message give a telephone number to reach you in case of some urgent matter (defined by client, of course) or the telephone number of whomever is covering for you while you are away.

(4) Breach of confidentiality allegations – this matter involved a client revoking her Release of Information (ROI), but the handwritten revocation apparently did not get inputted into the agency’s records such that when a request for information was made for client’s confidential treatment info by a subsequent therapist, who was charged with writing a report for court (and client did not want that person to get her older psychiatric history), the records were released thereby ignoring the revocation. LESSON: be careful if you work in an agency to make sure any revocations are received by the medical records staff. Solo practitioners – place the revocation at the front of the client’s file so you do not accidentally release the records without client’s new permission (ROI).

(5) Therapist saw client, then wrote up treatment plan that included diagnosis, and emailed it to client for review and comment and said they would discuss at the next session – client was upset about diagnosis and never returned, then filed grievance. Board saw cultural issues (was a low-income clinic) and also thought that the therapist lacked sensitivity about how the information might be received. HEED: do not send clients diagnostic or treatment information, but rather review such with them in a face-to-face session. Most therapists would not do this, but in this technological age, it might seem ok. For your protection, it is never a good idea to release client info without being present to discuss any questions such might raise for them. Even if clients want copies of their files, which under HIPAA they have a right to, have the client come into your office for the review so that if there are questions/concerns about something you have written in their file, you can assuage their concerns – and avoid a Complaint!!

Deb’s Louisiana Law Practice

(1) Case/Clinical/Legal Consultations – can be undertaken via teleconference or in person. Call or email for appointment. Flat fee for up to one hour is charged. I am in New Orleans every month or so to meet with licensees who prefer face-to-face in person consultations, but also can arrange consultations via Skype or video face time (with android phones).

(2) Defense for Licensing Board Complaints – with Social Work, LPC, or Psychology Board. Other health professionals are also represented.

(3) Adoptions – while I do not have an “inventory” of babies, many of my clients have found babies who are available for adoption through friends or relatives. The latter is easier to accomplish because it is an “intrafamily” adoption and much easier to accomplish. Stepparent adoptions are considered “intrafamily” adoptions, too. Private (non-family) adoptions are not extremely expensive, but do require a private Home Study by another social worker and that adds to the cost of that type of adoption.

Legal Services Offered

• Legal Representation & Consultation for grievances (complaints) to licensing boards and/or malpractice lawsuits
• Training & Consultation for Clinicians and Agencies (e.g., respond ethically to subpoenas while protecting yourself and your clients; identify high-risk clients and situations to avoid client disciplinary complaints and harm to clients or third parties)