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

Q: Therapist has seen client for six months or more when transference issues develop; that is, client begins voicing sexual attraction for therapist. Therapist deals with this transference skillfully, but client continues to escalate, asking to get together outside therapy, etc. Therapist skillfully sets appropriate boundaries, but client begins to “show up” in places where therapist frequents – coffee shops, Whole Foods, parks, etc. In fact, therapist begins to believe that client may be waiting outside therapy office at times and following therapist – stalking her, in fact. Client then begins posting derogatory fliers about therapist around small town where therapist practices. Client escalates and sends threatening letter to therapist’s agency indicating that client knows where therapist lives and that “she had better be careful or something could happen to her or to her family members.” What to do?

A: The scenario presented above is a serious clinical situation, especially because the client is escalating.  Clinical and legal consultation are indicated.  The client should be carefully referred elsewhere, but the consultation would involve how to accomplish that referral.  From a legal standpoint, is there sufficient threat to warrant a breach of confidentiality and a report to law enforcement to ensure the therapist’s safety?  Off the cuff, with only these facts, I would recommend that the clinical referral piece be attempted first to see if the transference issues can be dealt with clinically without involving the police. The clinician, consultant and lawyer should work as a team on this situation to monitor the client’s progress (IF she accepts the referral) and carefully watch for any signs of further escalation that might endanger the therapist.

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.

This month I will give a general overview of what occurs at the Board meetings and leave you on the cliff with a couple issues that have surfaced, which will be covered in the following newsletter.

First, at the inception of most Board meetings the Chair asks the Board members to introduce themselves, which they do around the conference table where they convene. Then the Chair usually asks member of the public in attendance to introduce themselves. Most folks in the audience are from programs that the Board may use (e.g., the Sex Offender Management Board; Domestic Violence Offender Management Board; etc.) and some of them are in attendance to make a report to the Board or present on their program (education for new Board members). Sometimes there are students from the various mental health programs pertinent to that particular Board meeting (e.g., social work students, or counseling students, etc.). The Board members really seem to like it when students attend and the Board members are on their best behavior!!

After introductions, the Board gets down to business and they rotate presenting cases (grievances) on the docket for that meeting. Each member presents and, after the presentation, makes a recommendation to the other Board members. Sometimes the presenter/member is not sure about a recommendation, and a discussion among the Board members ensues. If it gets too interesting (!), then someone will suggest they take it up in Executive Session and that’s it for the public discourse.

Although much of the actual decision-making involving specific cases occurs in the non-public Executive Session, much of what is discussed in the public portion of the meeting is helpful is assessing the various Boards’ concerns and opinions about certain issues and allegations against the licensed mental health professionals in that discipline.

For Next Month:

1. The Board cares about mandatory disclosures…
2. Many grievances are filed alleging “bias” or some type of unfair treatment of the client by the clinician…

Upcoming Events

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).

Learn More / Register

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)