Question/Answer Corner: What’s On Your Mind?
Q: I often get asked in consultations about how to respond to clients who have abruptly terminated and, as a part of that usually angry response to some perceived slight from the therapist (e.g., with clients who have disturbed object relations – perhaps BPD or some other PD), the client demands to see his/her therapy record. This may seem like a straightforward issue – clients have the right to see their medical information per HIPAA, right? But in the scenario presented, that is, a high-risk, angry, PD client, the therapist would be wise to handle this situation with kid gloves.
So how to proceed?
A: The reason many clinicians enjoy consulting with me is that I weave a clinical response into our consultations in addition to a strictly legal response. Both are important. I find that the more disturbed a client is, the more careful the therapist must be to these types of situations. The facts of the particular clinical history guide our plan for the therapist’s response and often necessitate a tiered approach to responding to the client’s demands.
For example, I may advise the therapist to try to set up a session to review the therapy notes with the client — telling the client that some of the notations may be hard to read or confusing, so the therapist would like to be present for the record review. If the client refuses, I may suggest that the therapist offer a brief, free session (e.g. 15 minutes or so) to conduct the joint record review. We generally tiptoe through a situation like this together, with the therapist offering one option to the client and then, if that one does not work, following through with another until we finally find something that works. The idea here is that a clinically “hot” situation is presented to the clinician and the response from the therapist requires not only a legal, but a clinically savvy response to avoid — if possible — a grievance being filed against the therapist.
In the cases like this scenarios that I have consulted on, thus far the results have been successful and, on occasion, the client even returns to therapy to continue working productively on his/her issues. Good luck to you all and please keep me in mind if a problematic situation arises.
Recent blog posts you might be interested in:
DORA: What’s On the Various Boards’ Radar?
I try to attend all the public Board meetings of all the Mental Health Boards: Social Work, Professional Counselors, Psychologists, Marriage & Family Therapists, Addiction Counselors, and Registered Psychotherapists. Each month, this section will address current issues that arise in various Board meetings that may seem helpful for practicing clinicians.
The meetings I attended this past month did not present any new information. I will just suggest that all clinicians review their forms and make sure they present a clear and informative picture of the treatment, including ways to cancel appointments without being charged. Also, as I mentioned in last month’s newsletter (these are all available on my website if you did not receive the previous newsletters), a careful review of your mandatory disclosure statement would be a great idea. The Boards are concerned about them being reflective of the new modifications. Make sure your policies and forms provide sufficient information that the client is fully informed and, thus, signs agreement to treatment that is truly an “informed” consent.
Also, for your information, if you are referred for a mental health evaluation by one of the DORA Boards, that evaluation is presently not available to you or your attorney. As a mental health defense attorney, I find this appalling and plan to challenge the policy is and when I face it with one of my clients. How can we defend whatever charges are levied against you if we do not have access to the results of the evaluation being used to substantiate your inability to practice? This is probably a rare situation, and often occurs more with applicants rather than current licensees, but it is a policy that frustrates me greatly.
What people said about my most recent seminar:
- “I always enjoy your trainings. I appreciate your flexibility in regards to discussing audience members’ concerns/experiences.”
- “My third seminar with you — you are great! Keep on teaching this class…”
- “Always great! Thank you! Wish you had more throughout the year… You are engaging and positive.”
- “Excellent! I could not think of anything to improve on this workshop. Keep doing what you’re doing.”
- “Excellent presentation. Very informative and well thought out frame work. Thanks Deb!”
- “Presenter was engaging, knowledgeable, and very thorough.”
- “Great seminar and very informative. Thank you!”
- “Very intriguing and engaging session.”
- “Nice work! Very interesting, especially when examining specific case studies.”
7:00 – 9:00 p.m.
Deb will present a 1.25 hour workshop entitled:
“Self-Protective, Clinical Practice with High-Risk Clients”
Deb will address how to manage risks with high-risk clients, how to respond to subpoenas for records or deposition/trial testimony, and how to effectively treat child/adolescent clients when their parents are divorced. Deb emphasizes self-protective clinical practice and includes how to best preserve the therapeutic relationship amidst all these challenging situations. Case examples will be offered and participants are welcome to present troublesome situations as long as time allows.
The Colorado Society for Clinical Social Work is again pleased to be offering the following educational and networking opportunities to our members and the community of mental health professionals. These informal workshops exhibit an excellent array of presentations by CSCSW’s more seasoned clinical social workers and other accomplished professionals from the community. They are hosted by members of the Society in their homes. Please contact us if you would like to receive evite’s to these Salons. Non-members will be charged a $30.00 fee (no charge for students).
NEW to Deb’s Practice
(1) Referrals being accepted for women’s therapy group to begin in the fall. Good candidates include women between ages approximately 30 – 60 who are undergoing a significant life transition, such as (a) loss of job, (b) major health issue, (c) divorce or death of partner, or (d) depression/anxiety that you believe group work would help. Client would continue in individual therapy with referring therapist – group would only augment clinical work.
If you would like to discuss a possible referral, please call me at 504.232.8884.
(2) Collaborative Divorce Mediation – if any of your clients are considering divorce, it might be helpful to encourage them to research the Colorado Collaborative Divorce Professionals web site. Deb is available to consult with clients who may have questions about the process, which is more non-adversarial by far than divorce litigation. Especially if the couple has children, collaborative divorce is much less destructive to the self-esteem of the kids (and the parents) and geared toward helping parents learn to co-parent effectively in a less conflict-ridden pattern. I am available to serve as mediator for the couple engaging in this process, which would also include collaboratively-trained lawyers for each party. If you want more information about the collaborative divorce process and/or ideology, feel free to email or call me.
(3) My therapy office in Lakewood (Green Mountain area) is available for reasonable subletting by day, half-day, or evening. Please check out my listing on craigslist or call me for more info or to schedule a time to visit the office.
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)
Deb Henson is an Attorney and LCSW (Tulane School of Social Work, MSW) in private practice in Denver and New Orleans, specializing in mental health licensing defense. She represents clinicians in DORA grievances (CO) and licensing board Complaints (LA) and regularly consults with clinicians in both states to help them deal with legal and clinical conundrums, such as: (1) the receipt of subpoenas for records or testimony; (2) the escalation of high-risk clinical situations; and (3) other sticky ethical wickets that arise in clinical practice. Deb helps clinicians develop self-protective, clinically sound and legally proper strategies for risk prevention.
Deb also maintains a clinical practice in Denver, with an office in the Green Mountain area of Lakewood. Through that private practice, Deb offers individual and couple therapy, primarily, and will be starting an ongoing women’s therapy group in the Fall (ages 35-65; interviews for group placement will be conducted this Summer). Referrals for the group are welcome – 504.232.8884.
Deb has been presenting half- and full-day seminars on “Avoiding Ethics Complaints and Malpractice Lawsuits” or “Legal and Ethical Issues in Clinical Practice” around the country through PESI, Inc. for over 7 years and presenting for many CEU groups in Louisiana and Colorado. She also has lectured for Tulane School of Social Work Continuing Education and the University of Texas School of Social Work (Austin) Continuing Professional Development program, and for many other clinical and counseling groups. Deb started her own training biz — Beyond Ethics, LLC — in 2009. Contact Deb for group presentations to agency staff and/or private practice consultation groups.
Deb can be reached through her law and social work web site: www.deborahmhenson.com or through her training web site: www.beyond-ethics.com. Deb can also be emailed at email@example.com or firstname.lastname@example.org. And, you can use the old tried and true method of calling her at 504.232.8884.