The hope is that by exposing such practices to the light of day consumers will recognize them for what they are and perhaps, just perhaps, therapists will think again before continuing these practices.
It is important to note that what makes such statements important to highlight is not that some therapist might have said them. Every profession has its “strange ducks”. However, all too frequently other professionals rarely have the courage to challenge them. It is this silence of the lambs so to speak that is the true misfortune and Pandora’s Box. It only takes silence on the part of the good to have the mediocre or the dangerous to prevail
We also want to acknowledge those individuals who embody all that is noble and good in mental health treatment. Please visit the Laurel Awards.
Therapist's who fly the seat of their pants
I interpret things and say whatever pops into my mind and don't worry about facts. I do interpret and judge. That is how I make sense of the world, especially the people world.”
My comment: On what planet or what universe? In a kangaroo court perhaps. That means that such a therapist will make judgments, diagnoses you etc.; come to all kinds of conclusion about you about you but, they will NOT be based on facts.
The sad fat is this therapist is not an isolated case. There are many therapist who would not know a fact from a free association. They are dangerous
Therapists who ignore the law and ethics of their profession
A dialogue between two therapists: Therapist A and Therapist B
Therapist A –“For instance, if a patient questions me at length, or even at all, about where I got my credentials, how much experience I have etc. etc., these are usually indicators that they're highly anxious/ambivalent and may not come or continue in treatment “ Therapist B- "I completely disagree. If I were looking for a therapist and found this kind of reluctance to discuss this with me, I would find someone else, thinking perhaps that therapist is not willing to be honest with me, might have something to hide, was too defensive, sees me as "less" than he/she is, an attitude I find common with some therapists."
Therapist A Says to me, “Where do you even begin with this type of ignorance?” Therapist A is referring to therapist B
There is ignorance here but not in my opinion from Therapist B. Therapist A is either ignorant of the laws and standards of practice governing the practice of psychotherapy or worse believes that they are above the laws and standards.
This situation rises to the level of Pandora’s Box on two counts.
First, it is very reasonable for a consumer to want to know everything professionally about a therapist. Their life is often in their hands. Why wouldn't they?
Second and perhaps even more important Therapist A thinks anyone who disagrees is ignorant.
How would they treat a patient who asked questions?
There are many therapists who practice in the manner of Therapist A. they can concoct all kinds of rationalizations for this behavior. They can couch it in “transference and counter transference issues. This does not take away the real fact that as a licensed professionals they have a ethical and legal responsibility to be candid about who they are ; their credentials and their scope of competence. If you doubt that call the licensing bureau of that therapist and find out.
Using Patients as a pawn in a power struggle with Managed Care Companies
When a managed care organization decides to reduce the fees it pays providers it creates a serious hardship on us. Livelihoods are at stake. One such company is doing so right now in the New York area. But that is not the Pandora's box story in itself.
Individually every provider must decide whether to accept the new rates or not. That is their right. Sometimes however providers attempt to get others to resign from the panel on mass hoping that patients complaints will act as leverage in their business dispute between them and the managed care company.
The problem is that some of those patients who must be made to complain may be people in need and hurting and they will not be able to get the care that they need. If a patient is in an acute crisis that could have catastrophic consequences. Access to care is critical in mental health. Hunting around for a therapist only adds to stress.
It is never acceptable to use patients as a pawn or bargain chip with a managed care company or anyone else. Never!
And, it may be against the law. Unaffiliated providers i.e. private practitioners may not engage in collective actions that will drive prices higher or restrain trade.
The same anti-trust laws that apply to giant corporations apply to psychotherapists also. It may not always seen fair to us but it is so anyway. It is supposed to be fair to you, the consumer.
These types of boycotts are self-defeating. Once they are discovered the managed care company will use it to show that all we care about is money. A few will ruin legitimate negotiations for the many.
Discussing Patients on Internet Listservs
Internet listservs are not private or confidential mediums. All kinds of lurkers could be there from drug company sales people managed care execs etc. and there is no sure way for listserv owners to know each members true identity.
Therapists sometimes go in detail about patients giving age, gender, marital status also a diagnosis and often personal private information that they disclosed in treatment. When you combine this info with the therapist’s name and town it is not too difficult to check with electronic medical databases and either zero in on one a few possibilities.
The technology on free listservs simply cannot insure patient confidentiality. Sophisticated encryption software must be used if it is to be done at all.
We recognize the limitations on our discussion group and will discourage therapists from going in to detail about specific patients.
Laura, Groshong, a respected colleague and representative of one of the major professional organizations states,
“The short answer is there is no way to totally insure privacy when writing about or presenting patient material but the chances of violating privacy are vastly increased if, even disguised, material is put out in the internet.“
My approach or first recommendation is to get patients consent and give them full access on the internet or anywhere.
If that is not possible, I strongly disguise the material so that there is little chance of using facts to make identification. However that will not work for supervision or consultation.
Believing Unsubstantiated Claims About Patients
In a discussion among therapists I over heard one therapist proclaim that they treated a patient who was a multiple child sexual abuser. However they proclaimed that despite feeling of “disgust and hatred for this person, “In the first second of the first session, those negative feelings went away. They then went on to proclaim that that is how they work. Negatives don't usually prevail.”
Well I could be my sarcastic self and ask how were they so sure it was the first second and not the second or third second, but the issue is too serious for sarcasm.
There was a serious problem. They concluded that their patient was a sexual abuser who ordinary people might feel disgust and hatred based on a second hand report, an intake report.
But an intake report without other evidence is just second hand information. What if he did not do it? This therapist has feelings of disgust and hatred for someone they never met before and never bothered to even ask the patient himself. Sadly this is not an isolated situation. Too many therapists make judgments about people based on subjective or unsubstantiated information despite our claims that we are empathetic and non judgmental.
When a therapist does not make a reasonable attempt to make their own assessment and obtain all the data necessary for a proper assessment that is not an honest mistake, but a failure to do their job.
To be sexually abused is a horrible thing. But is to be falsely accused and assumed that you are a sexual abuser any less horrible? See my article The Sexual Abuser Who Wasn’t
Sloppy or non-existent record keeping
There are a lot of problems facing therapists today from an over supply of us to new demands placed on us by managed care. It’s difficult work and it is changing all the time.
One way it has changed is in terms of record keeping. Once mental health records were considered the property of the therapist and even patients could not see them. Today their party insurers routinely demand information; patients themselves have the legal right to access. And increasingly records are being subpoenaed in court for a variety of legal matters including divorce and child custody disputes.
This is most frustrating for us since many of are concerned that this information we compiled to help you can be used against you. But there are ways of dealing with this and there are ways that are dangerous and not in keeping with professional standards.
While some therapists still take hand written notes, it is not acceptable to purposely make them so illegible as that no one can read them at all. What if something happens to us? That is not the way to protect a patient’s confidentiality.
Nor as some therapist have said that they attempt to get patients sign a statement that that they will not subpoena me or my records into court should their marriage end in divorce. Some have said they want patients to sign statements that say, "they refuse to have their session notes released and that it will supersede any other documents provided."
Now I have real doubts that such a document could stand up in court. It is essentially asking a patient to forgo any right to have their medical records used in their behalf in court at some time in the future or anywhere. Perhaps in less civilized countries that might work. I am attempting to get legal opinions from lawyers but let’s say for the sake of argument it is a binding document.
This means that a patient comes to us under stress of some type and we shove a paper under their nose saying you give up some of your legal rights or what? I will not treat you. What kind of empathy or caring is that?
How do sensible therapists deal with the problem of patient records being used against them in court?
First it helps to know the relevant laws. It helps to be prepared if a subpoena comes. Do you fight it, which means going to court to get it “squashed”? Do they learn the difference between a subpoena and a court order? Or, do they ask the patient what they choose and get a release if they decide it is in their interest? These are the considerations that a consumer centric therapist takes into account.
It is one thing to say to patients that they would prefer not to get in embroiled in legal matters. One can also say that if the patient chooses they might be a reluctant or hostile witness. But, the decision is ultimately the patient/consumers.
In short there are ways to do things professionally and ways that are less than acceptable. The end does not justify the means.
Forcing Clients to adhere to a therapy schedule that does not meet their needs
How frequent should psychotherapy be? Well I always thought it depended on the circumstances and the patient. Some people may need more and some less. It depends on the condition and what the patient can afford can’t be totally ruled out either. Well not so according to some of my colleagues.
Some therapists report that they contract with an individual to come on a regular schedule...such as 4 times a month regardless. Apparently some therapists expect their patients to commit and pay whether or not they need to see a therapist that frequently or not. Apparently cancellations with or without a reasonable notice are not permitted.
Now, I suppose if third party insurance or other contractual agreements do not prohibit this, there is nothing illegal about it. But is it good practice or even good business? I submit it is neither except under very special circumstances. Very special!
But there are some colleagues that may not agree of course. But is there way the only way? What if you heard this?
“Therapy Is weekly. It requires many boundaries, including consistency. This has nothing to do to with the therapist's "needs" It is for the benefit of the patient. Your questions suggest dilution of the "therapy." They sound like those of another untrained therapist who's in a rush to go into private practice for her own needs, at the expense of patients.”
Well that is an opinion. And I have mine. It reminds me, however of a line in a song from Man of La Moncha, “I am only thinking of you” It’s one thing to say you age going to set up such a rigid policy so that you can get bills paid. However claiming this is for the good of the patient?
Who is kidding whom? Will consumers licensing boards buy that? I don’t think so.
Go to the Laurel Awards
