How to Build a Trusting Counselor Patient Relationship
Summary and Guidelines of Fees in Therapy and Counseling. the nature of the therapeutic process and the boundary of the patient-therapist relationship. sessions, late cancellation, debt collection policies, insurance reimbursement, etc . What does a productive client-therapist relationship look like outside of the therapy room? Need help getting on insurance panels, but not sure where to start?. But sex between therapists and their patients still happens from time to time, Freudian slip: Therapist jailed for sexual relationship with a patient . Seniors With No Life Insurance Should Do This Before National Life.
He is co-author of the book, Law and Mental Health Professionals: Californiapublished by the American Psychological Association. A question asked of those of us who defend psychotherapists in civil suits and before licensing boards is what are the most common areas where therapists leave themselves vulnerable to attack.
The purpose of this article is to identify some of the more common pitfalls that psychotherapists may encounter in hope that they can be avoided in the future. Keith-Spiegel, American Psychologist, Vol.
Many licensing board cases and civil suits allege inappropriate or excessive self disclosure. There are two keys as to whether or not a particular disclosure is ethical: As an example, where a patient has a history of child sexual abuse it may be appropriate and ethical to disclose that the therapist has a similar background to establish a degree of empathy.
On the other hand, if the patient has no such history and the therapist is disclosing the information because of the therapist's own problems, it would be inappropriate. The question should always be "how does the disclosure aid in the patient's therapy. In addition, therapists must be conscious that excessive self disclosure can fuel a patient's perception that he or she is special to the therapist, or that there is a potential for a relationship outside the therapeutic one.
At that point the therapist should be inquiring as to what purpose this information would serve for the patient to know. Business Relationships with Patients There are numerous reported instances where therapists have entered into relationships of a business nature with present or former patients. There are very few reports of successful outcomes of such relationships.
In fact, almost every time such a relationship is reported it is reported in the context of a lawsuit being filed or an administrative action being taken because of the business relationship.
Regardless of how lucrative a potential business opportunity seems to be, a therapist must weigh whether that opportunity is worth the potential destruction of his or her career. The heart of the problem lies in the inherent unequal bargaining power between the parties once the therapeutic relationship has been established. It is almost impossible to establish that an arms length transaction occurred, no matter what legal language is used or what consents are signed.
Entering into a business relationship with a present or former patient will be viewed with suspicion by most licensing boards, and the burden will be on the therapist to establish that there was not some form of overreaching.
Obviously if the business does not do well, the burden to prove that there was no exploitation is even greater. Unlike self disclosure, which is a common occurrence, the rule for entering into a business relationship with a present or former patient should be "almost never. Using Techniques Without Proper Training A recurrent issue over the last ten to fifteen years has been the use by therapists of treatment techniques which they are not well trained in.
An example of this is in a case from New Hampshire, Hungerford v. A key point in the decision of the Supreme Court in New Hampshire allowing the father to sue his daughter's therapist was that the therapist's only training in the area of repressed memories was one lecture on memory retrieval techniques that she attended at a weekend symposium.
The therapist should not use any techniques without being thoroughly trained and experience in them. It is probably below the standard of care per se to use a technique after only being trained in it one time.
It is not uncommon with some treatment approaches such as EMDR or Bioenergetics for therapists to attempt to begin using the techniques before completing the entire training. Using Incorrect Diagnosis Deliberately Over the last several years as managed care has become more a part of a practicing psychotherapist's life, there has also been a rise in allegations that therapists are deliberately reporting diagnosis to insurance companies that are not accurate to trigger coverage where it should not exist.
Marchese, however, kept her job, kept seeing patients for another six months, and kept seeing Huckeby on the side. In February ofHuckeby told Oakwood that he and Marchese were engaged in a "serious, sexual relationship. This time, Marchese resigned. She surrendered her therapist's license to the state. Eventually, she was charged with two felony counts of sexual exploitation by a therapist.
Marchese declined to answer questions after she was sentenced to 6 months in the Kenosha County Jail. She is due to report to jail on November 29,two days after Thanksgiving. Some studies says as many as 10 percent of therapists have had sex with a patient. Others says it's closer to 2 percent.
And while it's even more unusual for a female therapist to exploit a male patient, Saunders says the damage is no less severe. Huckeby was recently committed to Winnebago Mental Health Institute after allegedly making death threats against Marchese. Marchese tried several times to end the relationship with Huckeby, but her attorney says he became obsessed.
And just last month, he made a shocking confession to FOX6 news. But his intent was clear. Like a Romeo and Juliet. She did this to him! Huckeby admits his ongoing threats to harm his former therapist are the reason he was committed.
Ethics & Malpractice
I will kill her and then I will kill myself. However, even those with excellent training and high levels of competence may relate unacceptably with those with whom they work because their own boundaries fail. Some may feel a need for adoration, power, or social connection.
The settings are private and intimate.
Freudian slip: Therapist jailed for sexual relationship with a patient | cypenv.info
The authority falls on the side of the therapist. Moreover, if things turn sour, the therapist can simply eliminate the relationship by unilaterally terminating the client and can deny that anything untoward occurred should a complaint be initiated by a client. Indeed, when a client walks through the door, immediate clues become apparent: Multiple authors have discussed the advantages of self-disclosure.
Done thoughtfully and judiciously, revealing pertinent information about oneself can facilitate empathy, build trust, and strengthen the therapeutic alliance e. However, those who engage in considerable and revealing self-disclosure with clients stand at greater risk for forming problematic relationships with them.
Instead, this client began to feel that the therapy environment was polluted rather than safe and clean. She quit therapy feeling even more adrift. It is difficult to know in advance how a given client will respond to a self-disclosure, particularly when the subject is in sensitive territory for the client. It seems reasonable to expect that some clients would want to know as much as possible about the person in whom they are placing so much trust.
A skillful therapist can respond without demeaning the client in the process. At the same time Internet searches make considerable information on anyone readily available.
Like any other individual who prefers some modicum of privacy, psychotherapists must understand that information posted on personal and social sites will become known to curious clients and may lead to inquiries or promote some other types of boundary blurring. See Kolmes, ; Reamer, The next case involves an indignant response to a fading career, compounded by an absence of close ties with family or friends.
Grandiose might elicit some sympathy were it not for her ill-conceived approach to dealing with her own issues.Patient Counseling on insurance
A well-known and outspoken therapist, Panacea Grandiose, Ph. However, Grandiose continued to maintain a successful practice, and her clients became the focus of her life. She hosted frequent social events in her home and invited herself along on clients' vacations. It seems that something about therapists either choosing to work in isolation, or the isolating conditions themselves, foster the potential clouding of professional standards of care.
How to Build a Trusting Counselor Patient Relationship
Or perhaps some therapists have experienced rejection by their colleagues, as with Dr. Grandiose, and turn to inappropriate substitutes for support and validation. Regardless of the reason, an insular practice with no provisions for ongoing professional contact diffuses professional identity, thus putting appropriate decision-making at risk. Therapeutic Orientation and Specialty Practices Some therapists practicing within certain therapeutic orientations are probably more vulnerable to charges of boundary violations.
For example, Williams notes that humanistic therapy and encounter group philosophies depend heavily on tearing down interpersonal boundaries.
Malpractice Pitfalls for Therapists
Such therapists often disclose a great deal about themselves, hug their clients, and insist on the use of first names. These therapists also become, according to Williams, vulnerable to ethics charges even though their practice is consistent with their training. Some therapists who specialize in working with a particular population or in certain settings may need to exercise extra vigilance because the nature of the services or service settings are conducive to or even require relaxed boundaries.
In such instances, very fuzzy edges may constitute an inherent element of practice rather than qualifying as inappropriate. Devine experienced deep sadness, hopelessness, and questioned her faith. At that time, Pew was dealing with his own troubles and struggling to manage his large congregation. Devine relayed her feelings, blaming God for having forsaken her, Rev.
Pew responded by pouring out details of his own family problems, including the particulars of a drinking problem in his youth. Pew hoped this intense session would prove helpful, figuring that Devine would gain confidence from knowing that even he had to face and overcome hardships. Devine, however, became upset by these revelations, passed them along to other parishioners, and left the church. He also interjected too much of his own life while failing to recognize that Ms.
Devine asked Pew for spiritual guidance only. Pew should have focused on his role as a pastor and simultaneously referred Ms. Devine to someone competent to treat her depression. However, therapists who belong to a religious community as parishioners can also easily experience challenging multiple roles.
Funnel Mask sought the professional assistance of Shudi Tell, M. Mask needed to talk to someone because, as the church treasurer, he was embezzling small amounts of money every week.
He was in debt due to family illnesses, and seemed to want Mr. Tell attempted to convince Mask to create some plan to make things right, but Mask expressed disappointment and left the room. Tell is in a bind.
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Even if he told someone, Mask had hidden his tracks well and could deny it. Finally, as job prospects become tighter, therapists have invented new marketplace niches for themselves.
Fido, the parents complained, charging him with incompetence.
Fido defended himself by saying that he was a licensed professional who loved dogs and that the family interfered with his relationship with the animal in ways that derailed the therapy. This defense was not persuasive to an ethics committee.
Training standards for many offshoots of psychotherapy are virtually nonexistent, expectations on the part of clients run high, and boundaries seem more likely to become confusing for both clients and therapists. Risky Career Periods No matter how long you have practiced as a mental health professional, specific risks link to each career development period.
We will briefly describe those that can be associated with early, mid-level, and later career stages. Therapists who engage in inappropriate role blending often come from the ranks of the relatively inexperienced.
Many have come from graduate programs where students developed complex relationships with their educators and supervisors. It may be that many therapists new to functioning independently have had an insufficient opportunity to observe professionals who have put appropriate boundaries in place. Kat Kopy, LCSW, enjoyed her last supervisor because he was funny and flirty and took her out for drinks after every session.
She decided that her clients would benefit from the same kind of relationship. Her client, Roger Rage, misunderstood her affable demeanor and their after-session coffee house excursions, and assumed that she was attracted to him.
When she recoiled as Roger attempted a kiss on her lips, he felt humiliated and angry. He slapped her face hard, breaking her glasses. The mid-career period can pose risks for those therapists whose professional or personal life has not panned out according to the dreams of their youth. Divorce or other family-based stresses involving teenage or young adult children, onset of a chronic illness, and apprehension about aging as well as other mid-career difficulties can impair professional judgment.
Research findings reveal that the majority of therapists who engage in sexual relationships with their clients do so while middle-aged. The next cases illustrate what can go wrong.
When a young woman whose self-esteem needed boosting showered praise on him, he anticipated her sessions above all others. Therapy was often followed by coffee and soon more extensive outings together and eventually ended up in a motel where the proprietor did not expect guests to bring luggage or stay for more than a couple of hours.
Pondent thought it best to terminate therapy as the relationship became more intimate, thinking that would shield him from future criticism. Unfortunately for him, the now ex-client became more insistent that they see each other even more often and in nicer places. Pondent, who had no intention to leave his family, tried to call off the affair.