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When Does Therapy Really Start? Managing Risk and Responsibility Before the First Session

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When Does Therapy Really Start? Managing Risk and Responsibility Before the First Session

When does therapy actually begin—and when does a therapist’s responsibility start? In this host-led episode, Curt Widhalm and Katie Vernoy explore the ethical, legal, and clinical risks that can arise before the first session ever happens. Through real-world scenarios, they unpack how unclear boundaries around consultation calls, intake paperwork, collateral contacts, and missed first appointments can unintentionally put both therapists and clients at risk. This episode offers practical guidance for clarifying client status, setting expectations, and protecting everyone involved at the very start of care.

Transcript

Click here to scroll to the podcast transcript.

(Show notes provided in collaboration with Otter.ai and ChatGPT.)

In This Podcast Episode: Client Status, Risk, and Responsibility at the Start of Therapy

Curt and Katie take on a deceptively simple question: when does therapy start? They walk through common situations that many clinicians face, including prospective clients reaching out in crisis, intake paperwork completed days before a first session, collateral participants who are not clients, and former clients reconnecting long after therapy has ended. Throughout the conversation, they examine how ethical standards, informed consent, and thoughtful communication shape responsibility, risk management, and client care—often earlier than clinicians expect.

Key Takeaways for Therapists: Clarifying Client Relationships and Reducing Risk

“This seems like a really simple question, but it gets complicated fast.”
Curt Widhalm, LMFT

Therapy can begin earlier than many clinicians assume, sometimes before the first scheduled session
Once a therapist and a prospective client mutually agree to treatment, responsibility may already exist
Intake paperwork disclosures, particularly around suicidality or safety concerns, require timely attention
Reading intake paperwork as soon as reasonably possible is an important risk-management practice
Clear communication about availability, crisis procedures, and response timelines helps protect both clients and therapists
Collateral contacts are not clients unless explicitly defined as part of the treatment unit
Thoughtful follow-up and documentation matter, even when therapy never fully gets off the ground

“Even though you haven’t seen them yet, if you’ve agreed to see them, you need to respond as though they are your client.”
Katie Vernoy, LMFT

Resources on When Therapy Starts and Ends

Articles from Curt:

Are You My Patient? by Michael Griffin, JD, LCSW
When Does Therapy Begin? by Brandt Caudill, Jr. Esq.

Relevant Episodes of MTSG Podcast

Meet the Hosts: Curt Widhalm & Katie Vernoy

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements)

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that happen in our practices, the things that happen in our lives. And we figure this is a January episode. This is the start of the new year, and we’re going to dive into a question that seems so obvious, so foundational, but this is a topic that kind of might terrify some people as they’re listening to it.

Katie Vernoy 0:49
Let’s start the year with scaring people.

Curt Widhalm 0:51
Yes, we’re going to talk about something real. We’re talking about, when does therapy start? Because as therapists, we might have all been there if you’re newer in your career, maybe not yet, but you get an email from a prospective client. It’s 11:30 at night, and the subject line says something like, need help ASAP. And you think, first, oh, my SEO is working. And then second, do I have to respond right now? So we want to be able to help kind of guide through a consultation call process, a way of being able to say, are you actually my client, or, more importantly, have you ended up actually assigning yourself as a therapist without thinking that you actually have done so. This is an episode around what is a seemingly simple question, but in the true Curt and Katie way, we are diving into the depths of something and making it extremely complicated, so that way we can circle back around to hopefully some very simple walk away points.

Katie Vernoy 2:03
That’s our goal. We’ll see how it goes.

Curt Widhalm 2:07
Now, one of the things that I like to do is not have these conversations necessarily be about the true black and white, very easy to define sort of things. This episode would be two minutes long if the answer was simply: therapy starts when people sign their paperwork and they come in and they pay you, and everything starts sounding very therapeutically. But it does get a little bit more murky than that. And there are some of the situations that maybe operate a little bit more in the gray rather than in the black and white. So Katie, if you will humor me as we go through maybe a few different scenarios here. And you can tell me some of the thought processes that you have, and we can kind of determine if some of this is things that people hadn’t maybe necessarily considered before.

Katie Vernoy 3:09
Sounds like a plan.

Curt Widhalm 3:11
So the first scenario that I’ve created here is a client calls you interested in doing therapy with you. After a 15 minute phone call, you both agree that you can be helpful for the client. You set a first appointment for the following week, let’s say seven days later, you send your client the intake paperwork through your electronic health record, you go on with your regularly scheduled week. You receive a notification two days later that your client has completed the intake paperwork. Now I know that you are an excellent therapist, and I know that there are many therapists out there who might not reach the level of Katie Vernoy, but when do you think that most therapists are reading that intake paperwork. And then I’m going to ask, when does Katie probably read this paperwork?

Katie Vernoy 4:06
I think, well, I don’t know when people are going to be reading the intake paperwork. I know that there are times for myself when I read it, when I get it because I have a spare moment, and there’s times when I read it in a process that I’ve loosely set up for myself, where I give my give myself a bit of time right before the session to review the paperwork. in depth. It is something that I’ve had a lot of questions about this too, because there’s so much more connectivity that we have as clinicians that we didn’t have before back in the old days, if I can put on my old person voice. I would, they might download and actually hand write their paperwork and bring it in. Or I would have them fill out paperwork. I would say: come early and I have paperwork sitting in my waiting area that’s actually, you know, actual paper. And so this wasn’t a question…

Curt Widhalm 5:08
The even before times you would say, come in even earlier. There’s a stone tablets and a chisel.

Katie Vernoy 5:15
Yes, the stone tablets and abacuses and all of those things, right? I think that there’s a different question that comes up, which is, when, when should I be looking at this stuff because of liability? And then there’s also this element of, what do I want to know before they actually walk into the room? If I read the paperwork too early, sometimes I have to then review it again right before session. And so it’s, I don’t think that there’s a clean answer here. of this is when I read the paperwork, and this is when you should read the paperwork. I think it’s what do you do once you’ve read the paperwork and you find things out? For me, I want to consider what was the conversation like? What is the established relationship that you know? Was it a 15 minute call? Was it more like an hour long call? Did the client seem in crisis when they approached me? Like there’s a lot of different ways that I might approach something depending on what I already know about this perspective, now I guess brand new client.

Curt Widhalm 6:32
I don’t want to shame anyone out there. I might imagine that there’s maybe more than one or two therapists out there who wait until right before that first scheduled session to actually open up the paperwork and look at it. Now, depending on the kinds of questions that you ask in your intake paperwork and background questionnaire and part of our entire processes about being responsive to clients. I’m actually going to encourage people that you should read that intake paperwork as soon as reasonably possible after it’s completed. Now I’m not saying you need to drop everything if you get that notification 11:30 at night, you can wait until next business day, operating hour kinds of things. Because my next question is, if that intake paperwork indicates suicidal intent, what responsibility does the therapist have and when? Because if that client is filling out the paperwork in the day or so after the consultation you’re not scheduled for seven days later, you have a client that is expressing suicidal intent. Does this in your mind shift some of the responsibilities here.

Katie Vernoy 7:55
These are the parts that get really complicated.

Curt Widhalm 7:58
And that’s why we do lengthy podcasts and not two minute podcasts like I talked about at the beginning.

Katie Vernoy 8:06
So I want to talk first about when you recommend people read the paperwork. I I think that expectation makes sense, read it as soon as is reasonably possible. And I don’t know, I don’t know what happens when someone is slammed back to back, or a client fills out a paperwork, fills out the paperwork on Thursday, someone’s off for a long weekend, and the session is Monday, and the plan is to review the paperwork Monday morning, right? I think that that still fits kind of within the reasonably possible review time, but there’s very different results if I read the paperwork 20 minutes before somebody comes in, versus when I read it six days before they come in. And so I think having some sort of policy or some sort of communication around how crisis might be managed if the client presents on the inquiry call with those types of concerns, I think that’s going to be something I’d want to take care of ahead of time. But you’re asking if I, you know, we have this lovely call on, you know, on Monday, and they fill out the paperwork on Tuesday. I’m not seeing them until the following Monday, and they’ve expressed suicidality on the Tuesday paperwork. I would want to know what what was possible to do to follow up. Now, what am I required to do? I think that becomes pretty murky, but what I would do, I think, is follow up and try to take care of this client, because I now see them as my client.

… 9:57
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Katie Vernoy 9:57
But what are the things that you recommend when you’re talking about these things?

Curt Widhalm 10:03
So I think I’m really glad that you’re bringing up kind of some different parts of this here, because my general recommendation is try and read it as soon as reasonably possible. That’s kind of the goal here. This is kind of the I’m not going to set it as best practices, because I think it’s more standard than best practices, but I do think that what you’re describing is there’s some wiggle room here, that if there are things that are going to impact significant portions of treatment that is codified into a lot of our ethics codes. I don’t have all of the codes pulled up in front of me, so I’m only going to cite the one that I’m most familiar with, the California Association of Marriage and Family Therapists; in informed decision making or things that really could affect treatment, if you’re not going to be able to read the intake paperwork because you’re taking a long weekend or something like the example that you just gave, tell people that so that way they’re not expecting you to be responsive until you return back. And this creates some of the wiggle room in my mind that, hey, I’m going to send you this paperwork. We’re going to meet on Monday. I’m actually going to be out of the office from later tonight until I get back to the office on Monday. I’m not going to be able to review it until then, you’re setting clear expectations with the clients about what your availability is, and while I’m citing the CAMFT code here. There’s echoes of that in all of the other major ethical codes. So that is kind of a good, healthy responsibility that you can have that sets clear expectations and some clear boundaries, so that way you’re not ending up in this scenario that I started this question.

Katie Vernoy 12:01
Well, I hear what you’re saying, and I caution against that a little bit, because my in my experience, is not that folks are filling out paperwork the next day, and there’s something ridiculously different than what we talked about on the on the inquiry call. My experience is that I’m trying to contact them first thing in the morning the day of and saying, Hey, where’s the paperwork? And so saying I’m not going to look at the paperwork until whatever time I think, potentially sets you up for not having the client fill out the paperwork timely. So the way that I communicate, so to get more specific on that, is I communicate in my paperwork it says when I’m available and not available, and so typically I’m not available evenings and weekends. It talks about in crisis, this is what you might want to do to respond. So they’ve theoretically sign those, those forms saying, If I’m in crisis, this is what I do, and this is, you know, this is how I contact Katie, those types of things. And I do ask them to complete it by the day before, so that I have time to review it before we meet. So some folks do fill it out right away. Most fill it out the day before, and so then I’m able to review it the day before. But I think unless you’re dealing with someone that’s in high crisis with the potential that they need coverage from the moment they’ve talked to you on the phone. And maybe this is just a reflection of a different caseload. If someone’s in that level of crisis, I would not schedule them a week later. I would schedule them sooner from the intake call.

Curt Widhalm 13:36
And that’s the wonderful part of me being able to make up questions, is, I get to create these scenarios out of thin air, because they could potentially happen. And these are some of the thoughtful considerations that we would want clinicians to be able to look at, because this does lead into the next question that I had asked or had prepared for you is, does the responsibility change if the client had called with the same information? So you’ve had this initial 15 minute call, you’ve agreed to a session a week later, you’re vibing, hey, I can help you.

Katie Vernoy 14:12
Sure.

Curt Widhalm 14:13
You’ve sent the EHR paperwork. They haven’t filled it out yet, and they call you up and they say, Hey, Katie, I’m actually feeling really suicidal right now.

Katie Vernoy 14:21
I think that’s very clear. You’ve committed to treatment, and they’re calling with a crisis. I think you you do your crisis response responsibilities, you would treat them as any other client. It just you have less information, and there’s not an established safety plan. So for me, that makes, that makes a lot of sense. When someone is filling out paperwork that they don’t know if you’re going to look at right away, I feel like I don’t know what the client’s expectation is. I feel like there’s, there is responsibility there, but I feel like there’s, it’s hard to know when someone’s going to read that paperwork. And so I guess, to your point, I don’t say this is when I’m reading the paperwork, because I want them to fill it out when I’m on their timeline, not wait to do it until the last possible moment. I say, if you have if you need to talk before, then if you have any questions or concerns, this is how you get a hold of me before our first session. So I guess what I’m saying is I actively set that up where the communication for crisis is different than filling out the paperwork. But we still haven’t answered the question, if somebody puts I’m suicidal on their paperwork, how do you handle that? I don’t typically have that. So I’ve not had to go all the way down that pathway, but the things I would consider, what’s, what are my options? But what is your what is your typical practice? What do you do in your practice?

Curt Widhalm 15:49
In this particular scenario, which has happened in our practice, and is kind of the basis for this, because while it seems like I just make up a lot of questions, whether it be for the classes that I’ve taught to university students, whether it be for law and ethics exams. Most of the time, I don’t have to make up questions, scenarios that are brought to life. Our practice policy for clinicians is, if this is communicated to you, you have a responsibility to reach out and screen for if there is a necessary course of action. So we would be responding before the first session saying we saw in your paperwork you indicated suicidal intent. We’re following up on that now to be able to determine if a progressive safety plan needs to be developed right then and there.

Katie Vernoy 16:47
Okay, so part of the reason for having your clinicians read the paperwork as soon as possible is to be able to do that.

Curt Widhalm 16:56
Yes.

Katie Vernoy 16:57
And that makes sense. That seems fair. I think the the piece that aligns more with how I run my practice is I give my clients the power to contact me if they are in crisis before our first session, I give them information on how to contact me and the limits of my availability, and then I do review it as soon as I can and respond in whatever way I can, but I don’t, I don’t feel that pressure to review the paperwork so quickly, because that’s not the mechanism I’ve asked them to communicate with me.

Curt Widhalm 17:33
And part of our paperwork does explicitly ask about suicidality and recent suicidality, and it’s part of the nature of the clients that we serve, and that does mean that we intentionally take some of these thoughtful steps as part of just our entire ecosystem.

Katie Vernoy 17:56
Yeah, I have those things too. I think I try to empower clients as much as much as possible to take their own actions. But that doesn’t necessarily mean they’re going to and so I think it is important to review and respond and recognize that even though you haven’t seen them in the office yet, or you haven’t seen them for a telehealth health session at this point, they’ve actually signed the consent forms from your example, but even you’ve agreed to see them on the phone, you need to respond that they are your client.

… 18:34
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Curt Widhalm 18:34
All right, I have a couple more scenarios that I want to move on to. Mr. Smith attends two sessions of his wife’s therapy. Has signed collateral paperwork, paperwork.

Katie Vernoy 18:47
But not the client.

Curt Widhalm 18:48
Not the client. Hey, you you are a collateral Mrs. Smith is the client. You are here. Mr. Smith also calls the therapist several times. Has had several phone conversations. I’m worried about my wife. I’m worried about the way that her anxiety is showing up. He schedules an individual collateral session with the therapist, and he comes into the session and he accuses the therapist of having an affair with Mrs. Smith. Mr. Smith then threatens to kill his wife when he gets home. Does a tarasoff warning apply in this case?

Katie Vernoy 19:29
You always do these tricky ones.

Curt Widhalm 19:33
That may be the best compliment that I have gotten from you in a long time.

Katie Vernoy 19:38
Yes, yes, you’re very clever and tricky here. You’ve made it very clear that this is a collateral, so not a client. So that would be a consideration. The question that I have, and this is one that we did not talk about before hitting record, so this might throw you a little bit, but when somebody comes in and they are expressing pretty severe distress or mental health concerns, and they’ve been an adjunct to therapy. Do we have a responsibility to try to address their mental health and make them almost de facto a patient or a client? Because if he’s saying, if he’s, I mean, unless you are having an affair, and then that’s a whole other episode. But assuming that this is more delusions, and now we’ve got violent intent. I mean, this is, this is a fairly dangerous individual, not that you necessarily want this client, but, but when somebody is right there in your room and you’ve you’ve said, I’m not your therapist. I’m a collateral. Is there any responsibility? Or could you step across the line and make them a client in some way, if you’re addressing their distress and it becomes an individual issue, versus what they’ve come in to talk with you about, for whoever they’re the collateral for.

Curt Widhalm 20:59
My thought process on this is it’s not really that different than if somebody calls you for an initial consult call and says, I have these desired goals for treatment. I have, you know, this presenting issue, I would like treatment in this way, and a clinician can’t provide that, whether it be scheduling, whether it be clinical skill, whether it be any number of reasons in some sort of consult, the clinician can have a reasonable: I Don’t think we are a good fit. I don’t have the ability to be able to work with you. I don’t work with clients who are starting out at this level of intervention, because you need to be in a place that can provide immediate treatment for you. Just because this person walks into your office, and even if it’s a scheduled collateral kind of session, they’re not a client, and you can have kind of that same thought process.

Katie Vernoy 22:13
So to answer your first question, this is not a client, so there’s not tarasoff applying here. It sounds like, oh, I would want to know what the collateral paperwork says, because if the collateral paperwork says there’s no secrets, there’s everything that’s focused on the client, you could just tell the client and there’s not a real issue there, but it still is this element of you want to make sure that you’ve actually had the collateral paperwork signed that there’s not any vibe that they are getting that now, the couple is a secondary client, because I think about family therapy, and usually there’s one identified IP, but the family is the client, And if a member of the family in that in that regard, all of a sudden came out with something like this, I feel like there’s, there’s some murkiness there. Collateral stuff is a little bit murky, especially if you’re identifying the patient as like the couple or the family. And so how do you keep that clean. I keep it clean by just having these collateral forms and making sure that I’m keeping the, you know, an individual patient. But you do a lot of family work, and you do some couples work. How do you how do you differentiate so that the clients actually understand that

Curt Widhalm 23:38
My collateral paperwork legitimately says you are not a patient.

Katie Vernoy 23:44
Yeah.

Curt Widhalm 23:45
You are here attending at fill-in-the blank’s therapy sessions where they are the patient. You are not afforded any confidentiality. I am not your therapist. I’m paraphrasing. I wish I could be this direct.

Katie Vernoy 23:58
I’m assuming it’s very nicely, well written.

Curt Widhalm 24:01
But it is pretty direct that I own no therapeutic responsibility over you. You are a visitor to somebody else’s therapy,

Katie Vernoy 24:10
Okay, but if this were a couple’s situation.

Curt Widhalm 24:15
If this was a couples situation where, yeah, that a client is you are correct in your answer. Tarasoff language is very specific. A client. A client communicates to a therapist, blah, blah, blah, blah, blah. So this one is, you’re right. It’s very tricky that terrasoff warning doesn’t apply to this situation because it’s not a client. But the other half of this is because it’s not a client no confidentiality is expected. So I would hope that you were a decent human being, and would take steps to warn Mrs. Smith in this case.

Katie Vernoy 24:52
And I think that the additional point that I was putting forward is you also want to make sure you’re very clear on what you’re defining as the unit of treatment, because even if Mrs. Smith is the identified patient, you’re going through her insurance, and you have engaged them in couples therapy, then tarasoff would apply, because now there is a consent, or implied consent, for the spouse as being part of the treatment. And so that’s where you know folks that do relational therapy with multiple people, you got to be really clear who’s actually in the unit of treatment.

Curt Widhalm 25:31
Wonderful point.

Katie Vernoy 25:32
Okay.

… 25:34
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Curt Widhalm 25:33
Next scenario, a therapist finished seeing a client 15 years ago and has since retired. The client calls the therapist wanting to meet and vent about some perceived wrongdoings during the course of treatment, and this is long after the statute of limitations has passed. The therapist agrees to meet the former client for coffee, and shortly after the meeting, the therapist receives notice that he is being sued for malpractice with the basis that meeting for coffee reignited the therapeutic relationship and the statute of limitations.

Katie Vernoy 26:10
So, before even going into whether or not the therapy was reignited, I just think that’s a bad idea. I mean, I guess if you’re bored, it’s been 15 years, theoretically, there’s a lot of I don’t know. I would be interested to find out what the complaints were, and I would want to be able to address them. But going for coffee, seeing someone in person, that’s just my reflection of I wouldn’t do that. I wouldn’t recommend that. I would potentially say, hey, let’s get on the phone and you can let me know what’s going on there, but I think you would still end up having the same thing. Does that reignite the therapeutic relationship if you get on the phone and have a conversation about why they didn’t like therapy with you? So does it reignite the therapeutic relationship? I feel like that we would need to understand what was the intent in meeting and how was that discussed. What is this meeting? Is it Hey, were two people coming into a coffee shop and talking about a former relationship, or am I agreeing, as a clinician to help you process what happened between us and addressing our therapeutic relationship? Because if it’s the second one, I think there, there is some, an argument that even though I’m retired, I don’t even have a license, which I guess then, you know, there’s that doesn’t even count. I mean, it sounds like the board won’t do anything, because, hey, this is a retired person, but, but if I’m saying, hey, yeah, let’s process this and make it all better, I would argue, yeah, we are reigniting the relationship. But if it’s clear, hey, I’ll come and hear you out. Let’s have coffee. Maybe it’s not. Maybe that’s not an agreement that’s happened. So I would want to know what was the agreement on how we’re meeting before I would decide if this is, if this lawsuit would have credibility to move forward.

Curt Widhalm 28:18
We will include a article in our show notes that it’s written by one of the CAMFT attorneys, Mike Griffin, and he writes several more different scenarios, and a lot of them are going to kind of encapsulate some of the murky endings around when therapy actually ends. But the one that really does seem to fit around this is also kind of very similar to the therapists, the well meaning therapists who say, you know, you can provide me with updates from time to time. You can give me a we’ve we’ve finished therapy successfully, you know, if you need a little bit of advice, you know, give me, give me a call. And that is really well meaning, but these check ins can be kind of boundary issues that you’re identifying here in this scenario. I didn’t even make this one up. I’ll see if I can dig up the article, but Brandt Caudill had written this for the California Psychological Association for an article several years ago. The Caudill article does say that, since this is not an agreement for treatment, that it’s not necessarily something that the therapist could be legally liable for, but I do think that it operates in a gray enough area that somebody could make the argument that, since they are talking about the therapeutic relationship and the therapeutic process, that it could be something where the therapist in this scenario is in at least more of a headache than they intended to be.

Katie Vernoy 29:55
Yeah.

Curt Widhalm 29:56
So really, a lot of the takeaways in this is to be really clear in your communications with people at all steps along the way: what is therapy and what isn’t? And so if you’re at the very beginning of treatment, and is this a client or not, my kind of you know, trying to create a sound bite takeaway on this is, if you and the person have both agreed for treatment, even if the paperwork isn’t signed yet, they are your client. If one or the other of you is not in full agreement, be really clear about that.

Katie Vernoy 30:41
So let’s I want to address the not completed paperwork one a little bit. If we’re on the phone, you say, Yes, I want to be your patient. I say, Yes, I think I can help you and I and I give you my paperwork, and I say, fill this out. We’re going to meet in a week. Make sure you fill it out the day before. You know, at least by the day before, so that I can review it before our first session. And you don’t fill it out, and we we talk, and you’re not ready for the first session, so we schedule another session, another week later, you still don’t fill out the paperwork. And, you no show. At what point are you no longer my patient, and do I need to send you that letter saying, Hey, you did not complete paperwork and you did not attend any appointment, so you are not my patient? Like to me, it feels like there is an there is an understanding at some point, this just didn’t work out. It didn’t get started. But when does your liability end? And how do you end that liability? Because if we’re saying somebody gets on the phone with you and says, Yeah, I want to be a client, and you say, Sure, okay, and the first appointment never happens and the paperwork doesn’t get filled out, you’ve still agreed, but treatment hasn’t started.

Curt Widhalm 32:01
According to the Griffin article, the general rule that he suggests is that therapists should attempt to contact the patients to make sure that the paperwork is filled out, to follow up on missed sessions, and while there is a certain amount of reasonable best, this isn’t you need to go in, proverbially, hunt them down. You should make and document what kind of attempts that you’re doing to follow up to make sure that the paperwork is filled out, to make sure that they are okay in kind of that termination process.

Katie Vernoy 32:40
Okay. So even if someone has not started, they’ve not completed the proverbial handshake, you still would need to terminate them.

Curt Widhalm 32:55
If that’s what your practice policies are. But it’s not just a de facto. You didn’t complete the paperwork, therefore I’m not responsible for you.

Katie Vernoy 33:03
Okay, okay, makes sense.

Curt Widhalm 33:07
I do want to close out by highlighting a couple of other pieces of advice from this Griffin article as well, that in your initial phone calls or in the scenarios Katie and I have heard of where some people will say, You’re not my patient until after the first session has been completed, which I don’t agree with. But there is kind of a broader process here. Mike Griffin suggests you need to inform prospective patients about the purposes of each step along the way. Hey, this is an initial phone call. We are not yet patient and therapist. This is to determine if we feel like we can make the step towards becoming patient and therapist. But really, what we’re talking about is if you feel like I can help you, and if I feel like I can help you.

Katie Vernoy 34:03
So first phone call is not therapy. It is an inquiry. It’s initial consultation that will determine if we are going to work together.

Curt Widhalm 34:14
And this is a direct quote from the article. “Although it may be tempting to offer suggestions or make recommendations to a prospective patient during the initial phone call, it is best to refrain from engaging in a manner that would suggest an established psycho-therapist’s patient relationship.”

Katie Vernoy 34:31
Got it so ask questions. Talk about how you work and say, I think there’s some things that we can work together on, and that would start at our next appointment.

Curt Widhalm 34:43
Exactly.

Katie Vernoy 34:44
Okay.

Curt Widhalm 34:47
We would love to hear your thoughts on this. You can follow us on our social media. You can follow us on Substack and LinkedIn and join our Facebook group. The modern Therapist’s. Group to continue on with this and other conversations, and you can find our show notes over at mtsgpodcast.com and until next time, I’m Curt Widhalm with Katie Vernoy.

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