Question/Answer Corner: What’s On Your Mind?
Q: I often get asked in consultations about dual relationships between therapist and client. The definition of a dual relationship in DORA’s social work policies is when a therapist is engaged in a professional role with a client and then also (1) “at the same time is in another role with the client” or (2) “promises to enter into another relationship in the future with the client or person associated with or related to the client.”
Examples provided include: (1) providing therapy to an employee of the therapist; (2) providing therapy to anyone who provides services to you, your colleagues, or your close relatives; (3) providing therapy to someone with whom you are engaged in an intimate or close friendship, or anyone closely associated with that person; (4) providing therapy to someone you supervise or teach; and (5) providing therapy to someone for whom you are also providing another service to that is not associated with mental health treatment.
Thus, for our Question of the month…
What if a client who is grieving over the loss of a child asks you, the therapist, to help the client establish a non-profit business in the name of that deceased child to help serve underprivileged children with the same illness? The client asks you because you specialize in some aspect related to the illness of the deceased child. The client says that this will help with the resolution of the grief because client will feel as though something positive will be created from the tragedy of the child’s death.
You, therapist, like the idea immensely and feel that it would be an appropriate time to terminate and/or refer the client to another therapist so you could assist client with the wish to start this non-profit business. Can you safely do this?
A: Probably not. The problem is that this discussion with the client has occurred during your treatment of the client and, according to #2 above, even your promise to engage in a future non-therapy relationship with that client may be perceived as a dual relationship with that client.
Beware! I am currently defending a very similar case in Louisiana and the therapist may be sanctioned for this type of action even though (1) the client requested it, (2) the therapist was well intentioned, and (3) the therapist appropriately terminated and referred the client to another therapist before beginning the nonprofit business.
Other recent blog posts you might also 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.
In last month’s newsletter, I said I would address a couple issues that have arisen as concerns at various mental health board meetings that I attended: mandatory disclosure form and allegations of bias.
The various Boards seem quite concerned with the Licensee’s mandatory disclosure statement and even if that was not an allegation of misconduct by the Complainant, when the Board reviews the records submitted by therapist, I have witnessed multiple occasions when the Board finds no merit in the actual allegations, but takes the matter into Executive Session (the non-public portion of the Board meeting) to discuss more in depth the mandatory disclosure statement utilized by the Licensee.
Beware! Make sure you are using the most recent Board-approved mandatory disclosure form.
As to bias, multiple grievances that are reviewed by Board members when they are presenting the facts of the complaint involve the allegation of bias on the part of the therapist against a client. The contexts differ, but the allegation is the same: the Complainant asserts that the therapist treated him or her with some type of bias.
This is a difficult allegation to protect yourself against. What I would suggest, generally, is that if you and a client are getting stuck in some manner, you take some time to fully listen to the client and directly ask if the client feels that you are understanding him/her and, if not, ask why not. If the relationship seems strained, be sure to check with the client to see if he/she feels that you are somehow unable to relate to the struggles due to some difference in culture, race or ethnic background, or some other difference between you. Better to bring out any feelings of this sort on the part of the client before he/she abruptly terminates and files a grievance alleging bias. It may not help prevent such allegation, but it may get the issue on the table for you to discuss and offer a referral to another therapist (or 3) who may share the characteristic that the client perceives you do not have in order to understand and relate to him/her. Any action taken in this vein should be well documented – explain in writing memorializing the discussion with the client that client feels a different type of therapist might be better able to relate to him/her and that client feels current therapist may not totally understand his/her issues as well as another therapist might. Have client review and sign approval with the remedial action taken. Or, if the discussion results in your continuing to be the therapist, but the issue was raised of possible bias, consider writing up the discussion and the client’s wish to continue in treatment with you as the therapist (again, have client read and sign).
I know this sounds a bit paranoid, but perhaps it might help defend a grievance alleging bias in the future if one arises. Better safe and sorry!
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.
(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.
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 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.