UPCOMING GROUP TRAINING
Tentative date: June 11th – evening or July during the day (Friday, usually)
- Therapists Over a Wobbly Barrel: Confidentiality versus Demands for Records or Testimony
- High-Risk Clients: Dealing with Demands, Harassment, Stalking, Threats and Other Adventures – Case Examples from Participants and Deb
- High Conflict Divorce/Separation/Custody Cases
- Ethically Responding to Subpoenas and Dealing with Attorneys
Case Examples Utilized in the Seminar
In the workshops, I always ask participants to send me case examples to discuss in the seminar. I also incorporate a variety of ethical conundrums for high-risk clinical practices from my law practice defending such claims when grievances are filed against clinicians. I also help clinicians understand how to prepare for depositions and/or trial testifying.
Trainings typically are three (3) hours and certificates will be provided for use with DORA upon renewal.
from MAY 31, 2019 TRAINING IN NEW ORLEANS
The May 2019 workshop in New Orleans had close to 80 participants!! The largest group ever, and it was a lively, participative group of seasoned clinicians.
I always ask registrants to submit case examples of their (or colleagues’) “nightmare cases” (the subtitle of the seminar). So many therapists submitted diverse situations; we had a fun and instructive time analyzing them in the seminar.
It was such a diverse set of situations – some absolutely clinically resolvable, some quasi clinical/legal, and some mostly legal (e.g., responding to subpoenas and filing Motions to Quash subpoena when the release is objected to by the therapy client).
Here are some comments from participants at the recent training:
- “I appreciate Deborah being both a clinician and an attorney. Frightening possibilities regarding DORA, but [she helped me] know what possible protections I can possibly provide for clients and myself.”
- “Great info – very knowledgeable and great examples.”
- “Very good! Lively! Engaging! Knowledgeable! Very important information. Perfect timing.”
- “Deb presented excellent information that I feel will help me with my practice. Excellent info! Great workshop.”
- “I attend multiple, legal, ethical practice trainings and Deb is excellent in presentation. Thank you!”
- “Great advice about staying balanced/grounded in testifying.”
What’s Up With DORA?
DORA is proposing that to consolidate all mental health boards under one umbrella. Here is more information on this from NASW-CO. The deadline to submit responses to DORA has passed, but I believe that all clinicians need to be aware of this attempt – if it does not get through this year, it might come up again.
From NASW-CO: (written to social workers, so this is the SW perspective, but much is applicable to other disciplines)
DORA did not mention a combined Mental Health Board in its November 2018 Mental Health Practice Act Sunset Recommendations, so we were surprised when DORA held a stakeholder meeting this week with the sole focus of seeking support for the idea of a consolidated board. Now that we know DORA is going to pursue this structure, it is vital that social workers voice their opinions on this matter.
Bottom line – NASW-CO opposes consolidated Mental Health Boards related to disciplinary issues for the reasons outlined below, as expressed by so many NASW-CO Members in our initial input to DORA over the past year. The considerations below are formatted similarly to the DORA Survey.
Considerations on a consolidated board similar to the Medical Board, which includes physicians and physician assistants, in response to DORA’s question:
While different medical specialties and physician assistants are consolidated under a common DORA medical board, all physicians have a medical degree and similar underlying standards of practice, whereas the educational requirements and standards among the mental health professions vary widely. Physician assistants are supervised by physicians, so, again, they are held to the same standards and there is much more consistency in how those professions can be governed. The purpose of the boards is to protect consumers, and this purpose is best met when the boards are familiar with the details of the discipline they are regulating.
The most serious problem with combining all Mental Health Boards is that the Boards are comprised of different disciplines, with vastly different educational and training standards, differing scopes of practice, and different ethical principles. This very issue raises questions about the ability of a combined board to ensure public protection.
A separate social work board for grievances and disciplinary actions of social workers is essential. Social work is a unique practice with different ethical principles, and extensive education and supervision, during and following master’s level training. A centerpiece of social work practice is the person-in-environment perspective and the strong advocacy for client empowerment. There are many other differences from the other mental health professions that make having a separate board necessary to keep the integrity of our profession whole in order to benefit both consumers of services and professionals who practice under their guidance.
Ideas for a different board modification that will meet the needs of Colorado, in response to DORA’s question:
Maintain separate boards for grievances and disciplinary actions, with shortened meetings as separate boards would no longer handle licensure applications. Expand delegated authority for Board staff to approve licensure applications by better guidance through Policies and Rules. A combined Board Panel, comprised of proportionate representation of the various MH professions, could meet monthly to review the most serious cases of “yes” attestations on the applications.
Registered Psychotherapists have no national recognition and no required education, training, and supervision related to practicing psychotherapy and should either pursue one of the other nationally recognized mental health disciplines in the MH Practice Act or find an alternate path elsewhere. This would eliminate one entire board and address the issue of those holding dual R.P. and other licensure status, as a number of R.P.s who have since obtained licensure fall under the R.P. board as well as the board of whatever license they obtained.
How to improve the proposed consolidated board structure to achieve positive impacts for applicants, licensees and consumers, per DORA’s question:/
The consolidation should only be relative to licensure applications. To assist all Board and Staff members in order to increase efficiency, move forward with the Rule Making process that was initiated in July 2018 and culminated in December 2018 Recommendations by the DORA MH Task Force.
Only consolidate one Board that meets monthly for review of more complicated license applications and permit more delegated staff authority. Disciplinary matters must remain with profession-specific boards in order to best protect the public. The Social Work Board now rarely has an issue with making quorum as remote attendance options are being increasingly exercised by Board members, and, meetings will be shortened if licensing applications are handled by a separate Board.
Share regular and more detailed (aggregate) data with the public, MH professionals, educational institutions, and professional associations regarding fiscal challenges and inefficiencies in processing applications and resolving grievances and disciplinary cases. We want to serve as resources and share expertise in order to help improve efficiencies in these areas. Access to such data will assist us in understanding problem areas so that we can best prepare emerging social workers for licensure as well as practicing licensees. For example, some ambiguities in social work licensure application processes, such as discrepancies between the checklist and online application, lead to delays. The process for licensure by endorsement, such as honoring supervision received in another state, also needs clarification. We can work together to identify ways to clarify the application process.
No other state has combined six separate mental health disciplines and a registration category (Registered Psychotherapists) into one large professional group in a single statute. States that do have smaller combined boards, most have only half the number of Colorado’s six mental health disciplines, report delays in handling complaints; increased costs; time-consuming difficulties in cross-training of persons from different professions; and time wasted in disagreements over standards for the group as a whole. In fact, prior to 1998, Colorado had such a system in place and dismantled it due to similar experiences.
Question/Answer Corner: What’s On Your Mind?
Q: This situation arose in a legal consultation I handled recently.
Clinician was seeing a 14 year old teenager brought to therapy by his mother. Parents are divorced and mom is the parent with whom the kid lives, but legally, the parents share joint custody (as is typical). The boy had reluctantly engaged with the clinician, but now they have a great therapeutic relationship. The teen does not want anything to do with the father who was abusive to his mom and emotionally/verbally abusive to the kid himself. Dad is pushing for visitation time with the teen, who resists.
Dad and his new wife live in Texas and have a therapist there (not sure why); that therapist sent a request for the clinical records of the teenager to Clinician. This was the presenting issue for the consultation: how should Clinician respond? If he were to share the records with the Dad’s therapist, the boy would surely lose trust in the fragile therapeutic relationship and close down entirely. Plus, the release would not help re-establish the Dad-Son relationship, but rather would undermine it due to the boy’s communications about his intense dislike/hatred feelings for his father.
But, does Clinician have an obligation to share records with another therapist?
A: We discussed this dilemma from a clinical as well as legal perspective, which is how I handle consultations. The therapeutic relationship is always paramount, in my mind. So, how to carefully handle this was the question.
You might say, “Well, just deny the records” but then Dad’s attorney would merely subpoena them. As a joint custody parent, Dad has a legal right to the records (any parent with joint custody has a right to medical, educational, etc. information about the children UNLESS the Court has restricted parental rights in some way, perhaps giving exclusive rights to the other parent). I always ask clinicians to obtain from their therapy clients the MOST RECENT COURT ORDER in cases of divorce so that the clinician knows who has what rights as to the minor clients.
I suggested that Clinician disregard the request for records until he met with Dad and Stepmother. I encouraged Clinician to attempt to establish some form of relationship with Dad so that he would understand Clinician’s dilemma about releasing records of a teen therapy client; that is, that if trust is undermined with teens, therapy is impossible.
Clinician had a session with Dad that began with much suspicion, but ended up well. Here are the comments from Clinician after the fact (he agreed for me to share):
When father and stepmother arrived, I presented them with my standard first visit paperwork that included a new form [Clinician had revised it a bit based upon our discussion]. I was pleased, and impressed, that Father signed the form indicating agreement with the policy before the session began. (I presented the same form to the mother who also signed with agreement). In general, once the father determined that a) I will not testify in any custody hearings, and b) will not take sides as to who is the better parent, he and stepmother relaxed and we were able to focus on what they want to accomplish (to forge a better father/son relationship), and that a major goal of treatment will be to help the youth develop the best possible relationship with both parents. The only sticking point, and this proved to be minor, occurred when Father asked when he would be able to have a session with his son. I counseled that his son has many issues, real, imagined, or engineered, to work out affectively before his son will be willing to see him in therapy. I explained this may take some time, and that it would be harmful to force the youth to participate in family sessions before he is ready. He conceded to this explanation. Father also agreed that there needs to be certain rules in place necessary to support the goals of treatment, not the least of which is that both parents will henceforth refrain from making derogatory comments about the other parent within sight and/or earshot of the youth. I addressed the issue of the consent for release for information to the therapist in Texas at the end of the session. Father said he would cancel that request given agreements made during the session.
This illustrates the principle of maintaining (or trying to, at least) an objective position with parents despite problems in the marriage. The crucial position for the clinician is to protect the therapeutic relationship with the minor client.
In this case example, Dad was expecting Clinician to be on Mom’s side, including in the litigation. He thought that Clinician would be drawn into the litigation battle and would testify that the boy should not be seeing Dad. When Clinician was able to establish a neutral position with Dad and his wife, Dad’s insistence on obtaining his son’s records was dropped. He relaxed and was able to learn that Clinician’s primary goal is to his teen client – not, to thwart Dad at Mom’s behest. The therapeutic relationship with the teen client was preserved! Very skillful handling by Clinician!!
We humans seem to love rituals, anniversaries, and recurring certain times to celebrate something. Birthdays are a great example. Each year on our special day, we celebrate our arrival in this world. That’s cool. As we age, we may not want to celebrate or call attention to another year added to the many, but even if we are more reserved about our celebration, don’t all of us have some special feelings on our special day?
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Training/Legal Consultation For Clinicians/Agencies
I have been providing training for high risk clinical situations and legal involvement of the therapist for individual clinicians and clinical groups in Louisiana and Colorado for some years now. I consult with individual practitioners, small groups of clinicians, and agencies to help therapists prepare for deposition or trial testimony, or to handle a subpoena request for clinical records.
Occasionally, I am available to meet in person with individual therapists who need risk prevention consultation and/or with groups of any size for any type of self-protective, clinical practice in this litigious age. I can custom tailor training to your particular agency or small group with questions submitted in advance by participants, if desired.
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)
Deborah (Deb) Henson is an Attorney and LCSW (Tulane School of Social Work, MSW) in private practice in Colorado and Louisiana, 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 has taught in the MSW programs at Tulane University School of Social Work and the University of Denver Graduate School of Social Work. She also serves as Expert Witness for litigation cases around the country involving assertions of malpractice against clinicians. She offers Divorce Mediation long-distance (Zoom; Skype; telephone) in Colorado and Louisiana. See her website for more details.
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 firstname.lastname@example.org or email@example.com. And, you can use the old tried and true method of calling her at 504.232.8884.