Let’s take as an example a situation where a consumer driving out a therapist’s office accidentally backs into the therapist car or other property. Assuming no serious injury, it is still is a difficult and awkward situation. Accidents can happen anywhere even in or adjacent to a psychotherapist office. Not long ago I received a request to write about the rights and responsibilities of both consumers and providers when there is some kind of accident (auto or fall of some kind etc.) in the therapist office or on the therapist’s property. The request was based upon a consumer reading the following account on an Internet discussion group frequented by psychotherapists. They were not sure what to make of it. Well they were not alone.
A therapist tells his colleagues that he had an experience where one of his patients backed up into his carriage house (actually an office in his home or residence) when leaving the office for a session. He did not see the actual event but rather surmised that it could have only be one and only one of his patients He expressed some surprise that his patient simply drove away. Now many therapists who did not actually see such an event might be somewhat reluctant to confront one of their patients with what is in essence a hit and run situation. Many therapists my self included might simply chalk the matter up as one of the costs of doing business and or refer the matter to their business liability insurance.
Even if they had actually seen their patient do it, many might simply let their respective insurance companies settle the damages an insurance claim. If you ever have been in a fender bender you would know that sometimes emotions can get in the way and it’s difficult to be objective. Was the patient actually fully at fault or did perhaps the therapist contribute to the accident somehow? Insurance adjusters are pros and are very good at looking at the facts of responsibility and often shared or proportional responsibility. Often times each party is judged responsible for a percent of the damages and it not always the full fault one party or person. Insurance claims adjusting is a profession itself and amateurs may not be the best to judge.
The therapist in question did not think it was an option to let the insurance companies deal with the matter as he clearly expressed that they might affect his insurance premiums. Of course he is right especially if he carried simply home liability insurance instead of reporting to his insurance carrier that he was conducting a business with a fair amount of commercial traffic out of his home. If that were the case his rates might go up but it also possible that his policy possibly could be cancelled for not being forthcoming with his insurer. Again you see homeowners insurance will cover accidents for a residence. But once you run a business out of your home it changes things and insurance companies might consider that a business and expect premiums commensurate with a business enterprise. It depends on the volume of traffic. If you have clients coming into your home regularly that generates more traffic that in most residences. It should cost more since the risks are greater. Manny psychotherapists fail to take that into account when setting up a home office.
For whatever reason the therapist in this situation simply took the matter in his own hands and used the next therapy session to confront the patient and demand payment. And as a result of discussing the matter with his patient in the therapy session the patient agreed to pay the therapist for full damages.
All’s well that ends well and if everyone is satisfied with such a solution that is the end of the matter. However I could not help but wonder what if things did not go as well. There are a number of potential dangers in such a situation and I would caution both therapists and consumers to think very carefully before complicating the role relationship. What transpired in the above example is a dual relationship. A dual relationship exists when a therapist engages in a role that is separate and apart from a therapeutic role.Now some young therapists or students have developed the belief that it is unethical to engage in dual relationship with patients. Well it can be, but not all dual relationships are necessarily unethical. Sometimes these dual relationships are unavoidable. The example above is one case. Nether the consumer or the therapist anticipated that an accident would occur on the therapist property but it did. And, the accident added an additional dimension to the relationship.
But what if?
What if the patient truly did not recall doing any damage to the therapist’s house or property?
Is it proper for the therapist to use therapy sessions to persuade a client to pay for damages that they did not think they are responsible for? Could it be possible that given the unequal power balance, the patient might feel pressured to agree to pay in order not to displease the therapist? Because of the special relationship between patient and therapist, it can be all too easy to put pressure on the patient and the therapist may not even be aware that they are doing it. Yes, therapist should be aware of such things but we are human too.
. And, should the client be billed for the session (or sessions) that deal with this alleged accident and not the original problem that brought the patient into therapy? I suppose it makes sense if the patient’s problem were being chronically accident prone.. Suppose the patient actually drove into the therapist’s property, but there were mitigating circumstances. For example in some parts of the country winters are severe with ice and snow. What if the therapist was a bit remiss in shoveling the driveway of ice and snow or had other obstacles that were contributing factors. Could the consumer make an equally valid claim that since the therapist was negligent in maintaining their property in a manner that is safe for the public they are just as or at least partly responsible? This situation could have been a sticky wicket indeed.Simple situation like this could lead to acrimony not to mention a poor therapeutic relationship.
While dual relationships cannot always be helped, most the therapists and their professional organizations and licensing boards hold that when a dual relationship is unavoidable it is the client’s interest that must take precedence. But can a therapist really do that if in fact he/she believes that their client damaged their property? They are not the patient’s therapist in that situation they are a plaintiff seeking damages.
Most therapists I know, in order to minimize the dangers of getting into dual relationships that will not have the patient’s interest foremost would simple let their liability insurance company handle the matter. However for those therapists who see patients in their home, they have a problem unless they were forthright with their home liability insurance company that they are running a business out of their home. But problem or not, does that change the responsibility they have to clients? Should the consumer bear the full burden because the therapist failed to take out proper and adequate liability insurance? Should consumers pay when a therapist’s chooses to cut corners?
What are the consumer’s rights and responsibilities in such a situation?
First, if in fact if they know they are responsible for damages to their therapist or anyone’s property they should compensate. It is the only honorable thing to do. However it is up to them and not the therapist whether to involve insurance companies. Again insurance company adjusters are truly experts and figuring out fair damages. It also removes much of the unpleasantness for the interaction by evolving third parties. Also there is a greater likelihood that therapy can possibly continue uncontaminated by extraneous matters. If the patient chooses to pay cash, it should be their free choice and not pressured by any therapist.
But, what if the therapist insists on full payment or the consumer has some doubts as to the fairness of the damages the therapist is demanding? Can one or should one use the psychotherapy relationship to work these things out? Many would argue against that.
In fact I believe if a consumer were to contact the therapists licensing board and present their side of the story the licensing board might very well agree with the patient/ consumer. If the consumer were to file a cross claim with the therapist home liability company it will then be know that the therapist is operating a business out of their home. Depending on the liability contact of the home insurance company, a therapist may well have wished he or she simply let the matter rest.
In short consumers have rights. Even consumers of psychotherapy. A related article is Playing Hardball that to specifics on what does if and when your therapist forgets that you come first
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