Nontraditional Modalities of Psychotherapy and the Standard of Care

Posted by Ivan Perkins, JD

October 23, 2017 at 11:59 AM

 

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Are all modalities of psychotherapy equal under the law?

Well, not exactly. The general “standard of care” is the reasonable care that would be taken, under the circumstances, by a practitioner trained and experienced in the particular school of therapy being practiced—as long as that school of therapy is recognized by a “respectable minority” within the profession.

If the school of therapy does not even have a “respectable minority” behind it, you are truly going out on a legal-ethical limb. This also goes for one-time interventions—for example, giving a “far out” homework assignment like telling a client to go skinny-dipping or attend a shamanic ritual. Just recognize that in the event of a lawsuit or board complaint, your treatment might be deemed below the standard of care.

But even for those therapeutic modalities supported by a “respectable minority,” you incur greater risk to the extent they are outside the mainstream. Non-traditional therapies include, for example, aromatherapy, light therapy, and animal-assisted therapy. The solution, other than avoiding non-traditional modalities, is to consult with a colleague, document the consultation, and document the client’s fully informed consent. We address informed consent in depth in our CE Course: Minimizing Legal-Ethical Risk in Psychotherapy, which provides a template informed consent form.

What should this documentation look like? Consider the arguments you would need to make, later on, if anyone alleged that your treatment was negligent. The documentation should support these arguments:

  1. you carefully considered the use of this modality for this particular client;
  2. you consulted with a capable and qualified colleague;
  3. you and the colleague reasonably believed the modality would not entail serious or undue risks for this client;
  4. you and the colleague reasonably believed the modality could benefit this client; and
  5. you fully explained the risks, limitations, benefits, and potential alternatives to the client, who voluntarily consented to this treatment.

Don’t be afraid to use this particular language in your notes, while fleshing them out in concrete detail. For example, specify why you think the modality does not entail serious risks, who your colleague is, and why you consulted with him or her.

The more “non-traditional” the therapy you are considering, the more it makes sense to provide an abundance of information, such as books or websites on the topic. You may also ask the client to sign a confirmation sheet that you have provided extensive information, they understand the nature of the treatment, and they are comfortable with the techniques you will use. This will show that their consent to treatment was truly “informed.” You could include all this information on your standard informed consent form.

Also, review your malpractice policy—and/or contact the insurer or an insurance agent—to find out if a particular treatment modality is covered. Insurance policies contain exclusions, and you want to avoid, if possible, a mismatch between your policy and your practice. See our guide to malpractice insurance contained within our CE Course: Minimizing Legal-Ethical Risk in Psychotherapy.

If you purchase any of our CE courses during the month of October, you'll receive a special introductory discount of 20% off! Just enter CEBLOG20 in the coupon code box at checkout. This code can be used one time per user. This offer will only last through October 31st, though, so act now for a great discount! You will have access to the courses for a year!

Sign up for a CE Course  TODAY!

 

 

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Topics: Professional Development, Continuing Education

Do you work for the VA or know someone who does? If so, check this out!

Posted by Bethany Vanderbilt

October 12, 2017 at 6:42 AM

Did you know? The Department of Veterans Affairs employs more than 12,000 social workers, marriage faVA Photo-2.jpgmily therapists and professional clinical counselors. The services these professionals provide are integral to helping veterans and their families. As part of Therapist Development Center’s (TDC) ongoing efforts to support our country’s veterans, and those who assist them, we are happy to announceTDC is now an approved vendor with the US Department of Veterans Affairs.

What does this mean for you? If you work for the Department of Veterans Affairs and are preparing to take your licensing exam or pursuing continuing education, it is possible to have the VA purchase your exam preparation materials and/or continuing education courses!

If you are interested in pursuing this option, talk with your supervisor and/or department representative. You may be able to work with them to complete a purchase order form with your information, including the fund number that will be utilized and TDC’s information, which can be provided upon request.

If you don't work for the VA but know someone who does, please pass this information along. We want to help! If you or your supervisor have any questions about this, please contact Bethany Vanderbilt, LCSW at [email protected]

TDC looks forward to helping you PASS your exams and pursue your professional goals with confidence!

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Topics: Exam Prep, LCSW Exam Prep, Continuing Education, Veterans, MFT Exam Prep, LMSW Exam Prep

Answer and Rationale for FREE Question on Record Keeping

Posted by Robin Gluck

October 6, 2017 at 11:59 AM

In honor of TDC's launch of our new continuing education courses, yesterday's practice question explored the legal issue of record keeping. Today we have the answer and rationale for you!

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QUESTION:

A therapist worked with a couple for several years following mutual infidelity. The couple separated after two years in treatment and is in the midst of divorce proceedings. The husband requests access to his records. What actions should the therapist take to address the legal issues presented in this case?

a. Inform the husband that the records belong to both the husband and wife and would require a release of information from both.

b. Request a written release from the husband and turn over all of the records, but redact information deemed detrimental to the wife’s well-being or therapeutic relationship.

c. Determine how access to records would affect the therapeutic relationship and the well being of the husband and wife.

d. Inform the husband that records belong to both the husband and wife and request the wife sign a release.

Answer:

  • The best answer to this question is A. The husband is requesting records, but the client is the couple and the therapist would need both members of the treatment unit to authorize release of records before doing so.
  • Answer B is too limiting in what would be redacted. Without a release from her, the therapist would need to redact all information for the wife, not just information that could be detrimental.
  • Answer C would be an option if an individual were requesting records, but that is not the scenario provided in this question.
  • Answer D is incorrect because the therapist is requesting the wife sign a release, which is inappropriate. Answer D would be better if the answer had the therapist asking the wife what she would like to do in response to the request, but the therapist should not request the wife sign a release.

This topic is explored in much greater detail in our second CE course and our social work and MFT programs prepare you for all of the legal and ethical questions that could show up on your exams!

Which answer did you choose? Does the rationale fit with your understanding of the law and how you would apply it in a clinical setting? Or did you learn something new with this scenario? If you have any further questions feel free to check in with a TDC coach. We are here to support you all along the way. And if you came up with the same answer-great job! You are on the right track to getting licensed.

Still haven’t signed up for an exam preparation program? Or have you already passed the exam and need to complete your continuing education requirements? Our structured, straightforward approach will provide you with exactly what you need!

You can learn more about our social work licensing exam prep HERE, our MFT licensing exam prep HERE, and continuing education courses HERE. If you’d like to connect directly with one of our coaches, you can do that HERE.

We look forward to helping you PASS your exam with confidence!

 

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Topics: MFT, Exam Prep, Professional Development, Continuing Education

FREE Practice Question: Record Keeping

Posted by Robin Gluck

October 5, 2017 at 11:59 AM

This week, we are excited to expand TDC’s professional development opportunities for therapists with the launch of our first continuing education courses. This first set of courses focuses on the laws and ethics of our profession. In honor of these courses, this week’s free MFT practice question will explore the legal issue of record keeping. More specifically, we will examine who has the right to access client records.

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When it comes to working with couples, record keeping is more complex than working with individuals. Some therapists try to simplify the process by maintaining separate files for each member of the treatment unit, with one record for partner A and another for partner B. However, this may not be advisable since the client is the couple and all treatment goals and case notes will pertain to the dynamics within the treatment unit. Thus, it would make more sense to keep a single file for the client (the couple) with this file containing information regarding both partners. It is important during the informed consent process to make this policy clear to your clients.

If you maintain a single client file, what happens if one member of the treatment unit wants to access the records? Since the records include information about more than one person, you would need to take steps to ensure confidentiality is being protected adequately for all members of the treatment unit. There are two options available to a therapist in this case. To meet the legal requirements of confidentiality, you would either want to set a policy that requires each member of the treatment unit to sign an authorization of release before sharing records with either party OR you can provide records to one member of the treatment unit with only an authorization of release from that member, but you must then redact (black out) all information related to the other member(s).

With this in mind, let’s take a look at the question.

QUESTION:

A therapist worked with a couple for several years following mutual infidelity. The couple separated after two years in treatment and is in the midst of divorce proceedings. The husband requests access to his records. What actions should the therapist take to address the legal issues presented in this case?

a. Inform the husband that the records belong to both the husband and wife and would require a release of information from both.

b. Request a written release from the husband and turn over all of the records, but redact information deemed detrimental to the wife’s well-being or therapeutic relationship.

c. Determine how access to records would affect the therapeutic relationship and the well being of the husband and wife.

d. Inform the husband that records belong to both the husband and wife and request the wife sign a release.

So, what would we do here? Leave your answer in the comments below and be sure to tune in tomorrow for the answer and a discussion of the rationale!

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Topics: MFT, Exam Prep, Professional Development, Continuing Education