COMMON CLINICAL CONUNDRUMS & LICENSING BOARD RADAR
Some food for thought … I hear these same issues in consultations over and over. No simple answers. Balancing risk versus benefit, which is why consultations are sometimes necessary.
I also hear certain themes that surface in Board hearings on disciplinary cases. When pertinent, I will offer some tidbits on what to beware of – a/k/a “licensing Board concern(s) du jour”!!!
Feel free to email me with ideas and I will share them in the next newsletter.
My topic for this year’s training in beyond Ethics, LLC (3-hour Ethics CEUs) concerns the risks for clinicians when seeing divorcing/separating couples and/or their children. At the first training on April 1st, we had a lively discussion about the “radar” of the mental health licensing boards in Colorado that are sanctioning clinicians who do not attempt to involve or at least reach out to both parents. One participant who regularly attends mental health board meetings in Denver said the Board referred to the duty as “independent verification” meaning that when one parent brings the child for treatment and says the other parent is not involved with the child, it is paramount for the clinician to independently verify that information. One suggestion for a parent who claims not to know the whereabouts of the other parent is to have them sign a form saying that the clinician has asked for information about the other parent’s whereabouts and that the parent signing attests that the information given the therapist is true. This may be seen as a CYA move and it is, but apparently this issue has surfaced frequently enough (via Complaints filed by the left-out parent, no doubt) that the Boards are stressing to clinicians that they must try to involve both parents.
Although this may seem like Colorado-specific information, I believe it is best practice both clinically and from an ethical standpoint. If the child has 2 parents (sometimes this is not the case, as in anonymous donor pregnancies or surrogates for single parents), both should be informed about the child’s mental health issues and needs. If one parent is ignored by the therapist – sometimes due to the badmouthing by the parent who brings the child client for therapy – that ignored parent may file a Complaint alleging bias and generally unethical conduct.
One parent even brought the therapist a Protective Order to show how horrid the other parent was … but upon further investigation (after the Complaint was filed), the Protective Order was only in effect as to the spouse and not the child. Thus, the purpose of presenting the Order to the new therapist was merely to do character damage of the other parent and keep the therapist from contacting that parent. It worked – except when the Board sanctioned the therapist for failing to reach out to the other parent of the child client. Beware!!! Seek consultation if unsure what to do.
With any luck and a great deal of magic, a skilled clinician just may be able to persuade the absent parent to have some involvement with the child in a therapeutic manner even if the parent has been uninvolved previously (which can occur for many reasons, obviously).
The other odd clinical conundrum that has plagued a couple of my consultees recently is the posting of negative, false reviews online. Related to that dilemma was another peculiar consultation involved the spreading of false and potentially very damaging lies about a practicing therapist by a random young woman, who allegedly was trying to impress her partner with a false ESA letter purportedly provided by this therapist and follow-up false stories about the therapist, who had never met the person spreading the rumors or the partner. Very odd situation indeed.
Let me know some odd situations that you or colleagues have encountered, and I will address them in a future newsletter!!
UPCOMING WEBINARS IN 2022
I always ponder a bit in the new year about what topic to choose for this year’s Ethics training. I thought about the context of many of my recent defense cases and consultations, and arrived at this topic:
Ethical, Self-Protective Management of High-Risk Cases and Legal Involvement
Description of workshop
Deb will discuss how to navigate your clinical practice ethically and self-protectively when working with high-risk situations that involve divorced and divorcing couples with children. Many of my legal consultations concern this demographic in the clinical practice; it is, by far, one of the most clinically challenging and ethically demanding areas of mental health practice. Therapists who work with children of divorced/divorcing parents frequently find themselves caught in a quagmire: they do not want to jeopardize the child’s therapy, but yet the demanding parents at war with each other often drag the therapist and the child into the litigation arena. Records are sought. Testimony is compelled. Therapists are anxious and understandably hypervigilant to avoid any misstep that might result in a licensing board Complaint/Grievance. The child’s therapy suffers. The therapist suffers.
Divorce and custody litigation can draw therapists into a black hole and destroy their ability to maintain a healthy, therapeutic relationship with the child client who needs them sorely.
This workshop will help clinicians prepare to handle these white-water rapids with a better understanding of how to shield themselves from harm, albeit probably not from all anxiety.
Deb invites participant discussion throughout the webinar and encourages registrants to submit specific situations in advance to enhance our grist for the training mill.
Two more chances to attend this webinar in 2022!
• June 10th
• November 4th
Additional Presentations by Deb this Spring:
- June 9th for Private Practice Clinical Consultation Group in Colorado (Zoom): “Divorcing Couples with Children: Ethical, Self-Protective Management of High-Risk Cases and Legal Involvement” – custom tailored to address the group members’ issues.
NOTE: If your agency, clinic, university, or consultation group would like a custom training, I am happy to tailor such to your needs. Together we can plan the substance of the training, case examples, length of training, etc.
What people said about my most recent seminars:
- “The April 1st session on Divorcing Couples with Children was … interactive and informal, balanced well with [Deb’s] knowledge and expertise in the area. I like that she and participants shared real cases that presented a challenge.”
- “Great job with Zoom. It almost was a good as being in the room with you.”
- “Very detailed, helpful … in navigating the legal world from a clinical perspective.”
- “Content was practical and presented in ‘layman’s’ terms. Easy to understand and able to take into practice immediately.”
- “Very thorough and helpful.”
- “Topic was very pertinent to many things I have experienced.”
- “Very helpful and plan to attend future seminars.”
GROWING MY EMAIL LISTS … Offer Still Open YOUR CHANCE TO RECEIVE … A DISCOUNTED WEBINAR OR LEGAL CONSULTATION!
I started this offer last year and plan to continue it because I want to reach as many clinicians in Louisiana and Colorado as possible to let them know about upcoming training and regular mental health information that might be helpful to clinical practice. That is, IF they want to be reached!! So, I think this approach is the most ethical I can think of to build my email lists. The best referral source, in my opinion, is from someone who has worked with me and/or attended my trainings and then refers me to their colleagues. So, if any of you know my and my work, please feel free to have the referred person mention your name.
In sum, please feel free to refer colleagues to me who wish to be on my mailing list for this mental health newsletter and emails regarding upcoming webinars. Here is what I stated in last years’ newsletters:
I would like to reach as many clinicians in Louisiana and Colorado as possible to invite them to webinars and to send them my Mental Health Newsletters. If you refer another clinician to me who requests inclusion on my mental health email lists (CO or LA), and that referred person emails me, asks to join the email list for her/his state, and gives your name as the referring clinician, YOU WILL BE ENTITLED TO 20% OFF A WEBINAR FEE OR 10% OFF A CONSULTATION FEE to be used any time within a year of the referral.
For those who refer MORE THAN ONE CLINICIAN TO MY EMAIL LISTS, YOUR DISCOUNT WILL BE 30% OFF WEBINAR FEE AND 15% OFF A CONSULTATION.
One more caveat: the referred person must be a NEW addition to my email list. My web guy will check it out for us; Brian is the keeper/manager of the lists.
DEB IS AVAILABLE FOR LEGAL/CLINICAL CONSULTATION and/or TRAINING
I am available to provide legal consultations for your high-risk clients or situations. I offer consultations to individual therapists or clinical group (e.g., clinical consultation groups, suite mates, etc.). I often schedule therapist consultations via telephone but can also schedule via Zoom if you prefer.
Additionally, I also can work with you to design custom training for your agencies, academic mental health programs, and small group practices. The trainings I have provided in the past have included a focus on: (1) ethically managing high-risk clinical situations and legal involvement of the therapist, (2) helping therapists prepare for deposition or trial testimony, and (3) responding to a subpoena request for clinical records or therapist testimony at deposition or trial.
If interested or need additional information, please email me: firstname.lastname@example.org.
PREVIOUS ETHICS WEBINARS
[NOTE: these topics/presentations are available for consultation groups, agencies, or university custom trainings – contact Deb for more information or to schedule.]
2021 (see agenda and description below)
June, September, November – a topic that will either intrigue or depress you: The Professional Will. Why would it depress you? Because most of us prefer to avoid the inevitable knowledge that one day we will no longer be around. This topic has been requested by some folks over the years but arises primarily from my several consultations with mental health professionals who had to “pick up the pieces” after a beloved colleague suddenly passed away.
In all my consultations, the mental health provider died, but some situations present a slightly different twist: the therapist suffers a stroke or other type of sudden, debilitating medical event. Poof! Clinical practice is OVER. Suddenly. Without the therapist’s ability to terminate or even email or text her/his clients. How will clients of the suddenly gone therapist be notified that their therapist will no longer be able to see them for their scheduled appointments this coming week?
These experiences that I have been involved with peripherally caused great angst in the mental health professionals who met with me to figure out what to do and how to do it ethically. They were torn between wanting to notify the deceased therapist’s clients but worrying about entering forbidden territory: CONFIDENTIAL MATERIAL IN CLIENTS’ CASE FILES.
This is the type of dilemma that a Professional Will seeks to avoid. Similar to a personal estate Last Will and Testament, the Professional Will involves planning for an untoward event where the therapist himself/herself has suddenly departed. Moreover, because therapist’s clients are notified ahead of time, the concerns about breach of confidentiality are eliminated; the client has given advance consent – and those of you who have attended my trainings in Self-Protective High-Risk Clinical Practice know I am keen on advance consents in your Intake paperwork because client’s agreement in advance protects you from breach of confidentiality Complaints/Grievances.
Additionally, as you have heard me say frequently in Beyond Ethics, LLC seminars, self-protective practice is not at odds with caring for our clients’ wellbeing, but rather ensures excellence in clinical practice. This is a great example. If you are self and colleague protective by creating a Professional Will, it also serves to give clients notice not only pertaining to the individual who would handle your caseload wrap-up, but also demonstrates to the client that you care for them enough to plan ahead to protect their confidentiality and continuation of care should something happen to you.
Anyway, for more on why we need Professional Wills, how to create them, how to advise our clients of their existence, how to prepare our practices and assemble a team of trusted others who will be ready to jump in … and lots more: Advance Ethical Planning for Therapist’s Unexpected Departure: The Professional Will!!
Louisiana and Colorado clinicians
- Ethical Obligation for Therapists to Employ a Professional Will (PW)
- When is a PW necessary?
- Do the Licensing Boards Require a PW?
- How does a PW Protect Clients’ Privacy?
- Specific Ethical, Clinical, & Legal Challenges re: Therapist’s Unexpected Exit from Practice
- Creation of the Professional Will
- Select & Prepare an Executor/trix (and Team?)
- Determine What Aspects of Practice Exec will Handle (only Clients or also Financial)
- Organize Clients’ Files for PW Purposes to Protect Clients’ Privacy
- Incorporate PW Information into Intake Paperwork – for New/Existing Clients
- Analyze Risks of Notifying Former Clients of PW
- Plan in Advance for Payment to Professionals who Assist in Implementing PW (e.g., attorney, accountant, copying and postage charges)
- Handling Termination of Existing Practice Checking Account, Any Joint (e.g., Co-Tenants) Checking Account(s) and/or Lease(s), and other Business Closure Details
Description of workshop
In the event of death, disability, or other unexpected circumstances that would prevent a psychotherapist from continuing to provide clinical services, a large number of tasks typically need to be completed, which should be set forth in the counselor’s Professional Will. This webinar will address the ethical obligations of counselors to engage in advance planning for such unexpected event. Deb Henson, attorney and LCSW, will lecture on specific ethical, clinical, & legal challenges, including a thorough analysis of methods to protect client confidentiality. Deb will also invite participants’ ideas, experience, and thoughts about this evolving ethical aspect of practice so often overlooked. The webinar will cover the entire process of planning and creating the Professional Will, implementing advance team preparation, and incorporating notice to clients by amending Intake paperwork. Although questions will be welcomed throughout the webinar, some time will also be left at the end for final questions or discussion.
Certificate of CEU/CPD:
Certificates will be provided at the end of the seminar.
March – there were about 30 mental health professionals in the Zoom webinar offered to both Louisiana and Colorado clinicians – Walking the Clinical High Wire with Couples, Families and Legal Involvement: Ethical Management of Risk.
One participant who had sent a couple scenarios to me in advance agreed to present them in our meeting. We had a robust discussion of ideas for her that morphed into other issues and analyses. Quite a fun, engaged, and productive 3 hours.
More comments from my most recent seminars:
- “Great topic and delivery – love Deb’s navigation of the grey areas. Thank you!”
- “I really enjoyed the training; it was quite applicable to practice.”
- “Information presented in a very clear and precise manner with relevant examples.”
- “Great info – very knowledgeable and great examples. Great reminders as well as some new nuggets.”
- “Could have listened to you all day! Great info. Lots to think about.”
- “Thank you for the best Ethics presentation I have been to in 25 years of practice. Your recommendations for protecting ourselves and our clients were exceptional! I will come to any presentation you have in the future. Thank you so very much!”
- “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.”
- “I thoroughly enjoyed your training. The intimate setting allowed for increased participation. I enjoyed the relevant examples/cases. I have been to Ethics seminars where the presenter went through the code of ethics (boring!). You discussed relevant issues that stimulated our interest in a fascinating way.”
- “Excellent presentation. Very informative and well thought out frame work. Thanks Deb!”
- “Nice work! Very interesting, especially when examining specific case studies.”
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 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.