Am I Honoring My Personal Values OR Am I Discriminating? An exploration of ethics for modern therapists
Curt and Katie chat about what therapists should be considering when their strongly held personal values or moral beliefs conflict with a client’s demographics, lifestyle, or choices. We dig deeply into when it’s okay to make a “values-based referral” and when referring out is discrimination.
This is a law and ethics continuing education podcourse.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we explore the difference between honoring our personal values and discrimination
Therapists are people who have their own identities, beliefs, values, and approaches to life. But what happens when those identities come into conflict with the clients that they serve? This CE podcourse explores the ethics behind therapist personal values, when personal values should dictate a client being referred to another treatment provider, and when that referral is actually discriminatory.
What is Julia Ward vs. Eastern Michigan University?
- An Orthodox Christian, master’s student in counseling requested referring out a LGBTQ+ client
- This student was dismissed from school because it was seen as discrimination and referrals were not allowed at that school
- There was a summary judgment and an appeal, leading to further lack of clarity
The State of Tennessee has a law that allows therapists to deny services to clients
- The law trying to overcome ethics codes
- The ACA protested by moving their annual convention out of the state Tennessee
How do ethics codes handle the conflict between discrimination and holding to personal values?
“We have to put ourselves in a position to treat all clients equitably and fairly” – Curt Widhalm, LMFT
- Do no harm, be truthful, practice within your competence
- Equity, fidelity and the call to not discriminate with a call to learn and expand competence with clients, and avoid abandoning clients
How do we decide whether we can or should refer out a client based on our firmly held beliefs?
- Ethical decision-making and our responsibility based on our license
- Sorting out client need, competence, and the benefit of the therapeutic relationship (i.e., common factors)
- Referral is a last resort and should be based on client need (not therapist preference)
- Advertising and branding for clients to self-select
- What happens when clients disclose things later in treatment
- The differences in the task for clinicians in private practice versus clients in organizations
Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide
Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!
Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.
You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/courses/am-i-honoring-my-personal-values-or-am-i-discriminating-an-exploration-of-ethics-for-modern-therapists
Continuing Education Approvals:
When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information
CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Saving Psychotherapy by Benjamin E. Caldwell, PsyD
References mentioned in this continuing education podcast:
American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author
Barnett, J., & Teehan, D. (2022). Ethics and values in psychotherapy. Psychotherapy Bulletin, 57(2), 11-16.
California Association of Marriage and Family Therapists (2019). Ethical Standards. San Diego, CA: CAMFT.
Grzanka, P. R., DeVore, E. N., Frantell, K. A., Miles, J. R., & Spengler, E. S. (2020). Conscience clauses and sexual and gender minority mental health care: A case study. Journal of Counseling Psychology, 67(5), 551–567. https://doi.org/10.1037/cou0000396
Grzanka, P. R., Spengler, E. S., Miles, J. R., Frantell, K. A., & DeVore, E. N. (2020). “Sincerely Held Principles” or Prejudice? The Tennessee Counseling Discrimination Law. The Counseling Psychologist, 48(2), 223–248. https://doi.org/10.1177/0011000019886972
Kaplan, D. M. (2014). Ethical implications of a critical legal case for the counseling profession: Ward v. Wilbanks. Counselor Education and Supervision, 53, 142– 146.
Lloyd-Hazlett, J., Airhart-Larraga, S., and Purgason, L. L. (2020) “Critical Knowledge, Points of Confusion, and Training Recommendations for Client Referrals,” Teaching and Supervision in Counseling: Vol. 2 : Iss. 1 , Article 6. https://doi.org/10.7290/tsc020106
Meyers, L. (2016). “License to deny service” Counseling Today
Ward v. Wilbanks, No. 09-CV-11237, Doc. 139 (E.D. Mich., Jul. 26, 2010).
*The full reference list can be found in the course on our learning platform.
Relevant Episodes of MTSG Podcast:
Conspiracy Theories in Your Office
How to Fire Your Clients (Ethically)
How to Fire Your Client (Ethically) Part 1.5
It’s the Lack of Thought That Counts: Ethical Decision-Making in Dual Relationships
Smarter than SMART: How therapists can improve goal-setting with their clients
Whole Person Therapist Episodes
Who we are:
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.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
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):
Announcer 00:00
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 00:15
Hey, modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com.
Katie Vernoy 00:47
Once again, hop over to moderntherapistcommunity.com for one CE once you’ve listened.
Curt Widhalm 00:54
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 where we talk about the things that affect our practices, the ways that we go about our business and how we can be better as professionals. And this is another one of our continuing education eligible episodes. So follow the directions in the intro and outro on how to do that. And this is an episode that we have covered some of these topics before across a multitude of episodes, we’ll link to those in our show notes, you can find those over at mtsgpodcast.com. But in our exploration of ethics, we are circling back to the question of discrimination, and particularly discrimination when it comes from therapists. And one of the wonderful things of having a podcast for several years now is that we have asked some of these questions before. We’ve come to some conclusions before. And before we dive into framing the problem and how it fits and how our opinions have either changed or gotten more into depth of what we’ve done before. Katie, how you looked at this differently over the last couple of years?
Katie Vernoy 02:13
Well, I think for me, the complexity of the problem becomes clearer and clearer. Because I think there’s there’s some blanket statements we can make, don’t discriminate, and/or be a whole person therapist and share your personal values and make it clear what you believe because there are some clients who need to know what your beliefs are because they may not work with you if they know. I think the pieces that I think have been hard to sort out and I’m hoping that we can get to some real practical guidance today. There’s our personal values, being authentic, being a whole person therapist, showing up as ourselves in therapy. There’s access and taking clients who we can serve best, but also not discriminating against folks based on gender, or, or a multitude of other protected classes. And then there’s also niche and, and competence and all of those things. And so I think there’s, there’s so much that goes into how do we decide if we work with a client, how we work with them, and when we refer out, and discrimination is just one piece of it. And so for me, I feel like really getting into the ethics and even some of the ethics that maybe if they’re not conflicting, they’re still a little bit at odds with each other and require some some real thought. And so, for me, it’s just it’s a nuanced question. And I think oftentimes we just yell, that’s unethical or, you know, I’m not going to work with those people. I don’t agree with them, or I think they’re awful or whatever, or I don’t think I could be competent with them, because I just whatever. Right?
Curt Widhalm 04:01
Right.
Katie Vernoy 04:02
And so I think I think we get into simple overarching statements. And I don’t think that that’s actually what, what we’re what we’re looking at as therapists. I don’t think it takes everything into account.
Curt Widhalm 04:13
Well and I think, you know, our discussions and leading up to this episode, part of, you know, the really wonderful preparation that we do, and the arguments that we get into before coming up with some kind of a coherent story. If you want to see some of that stuff, become a patreon member, and we’ll share some of those things with with our patrons. But part of what really came up in a lot of that discussion, and you’re bringing it up here again, is the ethics codes. While we have singular pieces of them that apply in certain situations, it’s looking at the code as a whole that ends up leading us to being able to make good ethical decisions in this stuff. And part of Where this didn’t necessarily happen is probably with the most infamous case of personal values versus ethics, which is Julia Ward versus Eastern Michigan University.
Katie Vernoy 05:13
Lay it on me, what is that one?
Curt Widhalm 05:15
So, Eastern Michigan University is a public institution. And Julia Ward was a Christian student in its master’s degree program in school counseling. This would have been around the year 2010. And the school in their practicum, amongst other things, binds their students to respecting the diversity of clients and amongst things like the ACA Code of Ethics and Standards of Practice. Now this students identifying as a devoted Christian student was assigned a client who identified as homosexual. And the student made known to the university, assuming supervisors, practicum instructors and stuff that are her beliefs held that homosexuality is morally wrong, and it conflicts with her Orthodox Christian beliefs, and that she would not engage in a gay affirming counseling, and requested that this client be referred to somebody else. The university’s policies said, That’s not how we do things here. This is a client who’s assigned to you. We don’t refer out. And amongst a number of back and forth, ultimately, Julia Ward was dismissed from the university. Story doesn’t end there, because Julia ended up suing the University for a wrongful dismissal, including that this was against her free speech. That she had civil rights and a free exercise of religion, as evidenced by the First Amendment and that these were violated by her dismissal from the school. And if you are looking for the legal case, this is Ward v Wilbanks et all, and pits religious freedom principles against the rights of public universities to run their institutions as they deem appropriate, especially in the education of professionals and ultimately, professionals that serve the public. Both the graduate students, Julia Ward and Eastern Michigan University moved for summary judgment. So this is where the initial court just kind of looks at the case on its merits, and issues a judgment rather than going through a trial. And the court granted summary judgment in favor of the university and ruled against the student. And this was largely due to being tied to a professional code of ethics, namely, the American Counseling Association, Julia eventually ended up appealing this decision. And this went to the US Court of Appeals for the Sixth Circuit, which issued its decision on January of 2012, which reversed the trial court’s grant of summary judgment in favor of the university. And what this did is sent to the court or sent the case back to the US District Court for further proceedings. And ultimately, the case ended up being settled out of court where neither the university nor Julia ended up, you know, really pushing for this to go to trial. The university…
Katie Vernoy 08:25
Why was, why was the appeal allowed? Like why did the appeal overturn the original what was what was the argument there?
Curt Widhalm 08:33
The appellate court decision said that the ACA Code of Ethics does not prohibit values based referrals like the one requested by Ward. The decision explains that the point of the referral request by Ward was to avoid imposing her values on gay and lesbian clients. The court, the applet court pointed out that another section of the code of ethics extremly permits values based referrals. The provision referred to by the court, which is Section A 11 B inability to assist clients, states that have counselors determine an inability to be a professional assistance to clients. They avoid entering or continuing counseling relationships. Section also says that counselors are knowledgeable about culturally and clinically appropriate referral sources and suggests these alternatives. And the court went on to cite other examples supporting that its assertion that value based referrals are not prohibited in the counseling profession. So what this ended up with is, even though the appellate court turned it back to the trial court, and since it never actually went back through the trial court for an ultimate decision, nobody ended up with any sort of legal final definition on what the law says. So the decisions kind of ended up to where everybody feels like they could win in this.
Katie Vernoy 10:04
Well, and I think it shows the challenge, because there are these different parts of the ACA code of ethics, that speak to this very issue and provide different suggestions.
Curt Widhalm 10:17
Right. Now, amongst the discussions that we’ve heard of things over the years, when it comes to values based referrals, discrimination, that kind of stuff is things like, well, clients who would be, you know, going to somebody with strongly held Christian beliefs like this who identify as LGBTQ plus, wouldn’t want or benefit from those therapists in the first place. And while there is potentially some clinical truth to that, it does speak to the very core of our profession of why we have things like ethics codes in the first place, versus waiting for people to get upset enough to actually go to trial and not just have summary judgments overturned, and that kind of stuff. And instead, what you get is riveting podcasts about law and ethics, that help dive deeper into why we do the things that we do, how we’re taught to think ethically and not just pick and choose which parts of the ethics codes that we want to apply to a certain situation. But as Julia pointed out, as the university pointed out, as the appellate court pointed out, we kind of if we only look at one aspect of things, we can do all sorts of mental gymnastics to get to how we’re justified in the actions that we do. And that’s not necessarily why we have ethics codes in the first place is to just kind of have some sort of pick and choose which way to be able to behave.
Katie Vernoy 11:54
Yeah, choose your own adventure of ethics, ethical behavior. So, so before we we move forward a little bit, I just want to comment on, we still haven’t really got an answer. Like there’s there’s not a specific here of is it discrimination? Is it a values based referral? Is it competence? Is it whatever like, like legal minds have have come to this task and said, Oh, we could go either way.
Curt Widhalm 12:29
Right. And that’s where, again, this is maybe a little bit more of an ethics discussion, rather than a legal discussion.
Katie Vernoy 12:39
Fair, fair enough.
Curt Widhalm 12:40
And, you know, to really point this out and, you know, our our founding principle book that we always refer to ‘Saving Psychotherapy’ by Ben Caldwell points out that the reason that we have things like ethics codes is who better knows how our profession should operate than those professionals who actively work in it. That if we wait for lawyers and judges and politicians to set rules for us, I mean, how many of the things do we tell even each other of like, all right, you don’t understand something about working with this particular population, let alone some, you know, restaurant owner from the middle of nowhere, who ends up in Congress and, you know, makes funny tweets. You don’t want people like that running to, telling us how to run our profession. So instead, what we have is our ethics code. So the people who know what we do, and ultimately, these are the people who say, these are the aspirations that we look out for as holding up our entire profession to continue to have trust in us and the people who do our services.
Katie Vernoy 13:52
So I like the word aspiration. I want to hang on to that for later. But when we were talking about this, there’s also in kind of framing what we’re talking about: the state of Tennessee, and so maybe you can tell that story.
Curt Widhalm 14:05
So in 2016, the state of Tennessee and I’m pulling from an article by Grzanka, Spengler, Miles, Frantell, and DeVore. Grzanka has written a lot about discrimination and ethics and his, we’ll throw a few articles by him in here but especially around this Tennessee law. So an in 2016 Tennessee became the first state to allow counselors and therapists in private practice to deny services to any client based on the therapists ‘sincerely held principles.’ That is quoted ‘sincerely held principles.’ The laws proponents framed mental healthcare ethics as infringing on counselors religious liberties, but its critics denounced the bill because it apparently targeted LGBT+ individuals. So this was still on the books. But at the time the annual ACA convention was scheduled in Tennessee. And when this law came into effect, the American Counseling Association had such a reaction to this, that they ended up uprooting the entire convention and moving it out of the state of Tennessee. Moved it to California with like, two months notice. And Katie and I have run conferences before. That is no easy or cheap process. But…
Katie Vernoy 15:39
That is an investment in a protest.
Curt Widhalm 15:41
But this was really looked at as a kind of opening up the, you know, legal restrictions that therapists would be facing when it came to discriminating against their, quote, sincerely held beliefs. You know, I don’t want to get into tit for tat, you know, sorts of things or straw man equivalents throughout here. But I am going to use as an example, throughout this episode of potential clients that, you know, with sincerely held beliefs, conflict by therapists. And so we’re gonna go back to my favorite example, in all of this, and we will just use therapists who discriminate against clients who like seeded grapes. And this will be our stand in because I think discrimination can take a lot of forms, in a lot of different ways. And in the discourse of how we talk about things and just to keep this from being targeted against any one particular one. We will just use people who like seeded grapes as the villain.
Katie Vernoy 16:50
And if you’re wondering why seeded grapes is here, we’ll put the episode that it’s in in the show notes over on mtsgpodcast.com What it was on?
Curt Widhalm 17:01
It was on conspiracy theories.
Katie Vernoy 17:02
Oh, conspiracy theories, conspiracy theories. So So framing the problem. Now we’ve got at least one state that says you can discriminate….
Curt Widhalm 17:12
Oh, there’s been several more since then.
Katie Vernoy 17:14
…religious beliefs. Okay. So there’s laws that that are there. But then, if I’m remembering correctly, ACA came back and said, and you still have to follow our follow the ethics code.
Curt Widhalm 17:24
That’s right. This is still an ethics episode.
Katie Vernoy 17:27
Yes, yeah. So this isn’t a legal episode. This is an ethical episode. But I think we’re, we’ve got folks at different levels in different places saying, you have religious freedom, you don’t have to work with people you don’t want to. And even laws and Supreme Courts and different things grapple with this, this nuance, or not even nuance, this decision over and over again, around either around whether that law is actually legal. Can you can you actually discriminate based on religious beliefs? We’re not going to, we’re not going to stay there because the ethics says you cannot discriminate, but the ethical codes actually have a lot of different things. And I actually found some, so I’m gonna I’m gonna mention some right here.
Curt Widhalm 18:10
Go on.
Katie Vernoy 18:12
I, Yes, thank you. There’s no malfeasance which is: Don’t do harm. And potentially if you have a sincerely held belief, you may do harm, either intentionally or unintentionally. I think if it’s intentional, then you discriminated and you’re a bad people bad person, but like or bad therapist, I guess is more accurate. But we’re human. There’s also veracity that’s, and this is in the ACA preamble, I actually wrote things down because I was like Curt will want me will want me to cite where I found this stuff. And so you have to be truthful. And so if you are a therapist that believes being queer is bad and wrong. Do you have to be truthful about that? And that would potentially then go back to causing harm. A 4 A is also saying avoid harm in a non, Oh, and in that you can practice, you have to practice in a non discriminatory manner in within the boundaries of professional and personal competence. And so then it speaks to competence. If you have no lived experience, or if you you’ve been raised to believe some of these, quote unquote, lifestyle choices are wrong, you know, can you be personally and professionally competent with them? And does this give you kind of some, some room to refer out based on competence? C dot, C point 2 A says, oh, yeah, I think it’s A, there’s boundaries of competence, but you have to it requires a multi multicultural counseling expertise. So you have to have competence multiculturally across everything, but if you have a limit of competence, then then you can refer out and so then it becomes What is culture? Is disability culture? Folks in the disability movement would say yes. So, so there’s, there’s a lot of stuff there. And then there’s also in new specialty areas, you can’t practice until you’re competent. And so having someone come in with a type of a type of seeded grape that they like, that you know nothing about, and you have no competence in, you theoretically can’t work with them until you’re competent. I had extra time this morning. And then there’s also the C point 2 point G, which is impairment: don’t practice when you’re impaired and identify when you are impaired. And if you have a strongly held belief, if that there’s you don’t have to stop practicing completely, but you may have to limit your practice if you’re impaired. So to me, when I look at all of this together, and you’ve called it mental gymnastics, but when I look at all of it together, there are some real challenges here because we should not discriminate. And it’s I think, it’s, it’s easy for a lot of us as therapists to say, Okay, I I’m not going to discriminate with for, for protected classes. But even protected classes, say gender, they don’t say, gender identities that are typically marginalized. So we cannot discriminate discriminate against men, for example. And we have whole episodes on this. You know, there’s also, it seems obvious that we don’t discriminate based on religion. But, you know, we, like our episode on conspiracy theories, there’s a lot of beliefs that we strongly disagree with. And if someone comes in believing in seeded grapes, for example, and we strongly disagree with them, do we have the competence to work with them? And so it gets into this this nuance of what is discrimination? What is competence? And what is culture? Because the ethics codes directly say you have to continue to train yourself on culture. But as we’ve done, you know, 300 episodes almost at this point, most of the time, cultures and subcultures, the first, you know, the first question we ask is What do therapists get wrong? Therapists get a lot wrong. And there’s a lot to do to stay aware. And depending on how we set up our practice, or how much time we have, especially in, you know, public agencies where folks have gigantic case loads or like you have a gigantic caseload, like there’s not time to train and learn about every single client for hours every week. And so it gets really it gets really complex to me. So did I frame it, did I make it as confusing and complex as possible?
Curt Widhalm 22:49
Those are really good points.
Katie Vernoy 22:53
Thank you.
Curt Widhalm 22:56
And…
Katie Vernoy 22:57
Then you’re going to now refute them all.
Curt Widhalm 23:00
I’m going to add to them because part of the, I really do encourage you to become a patron like just to see what we came up with out of this episode and part of our discussion off air. And just previewing it is: we talked about if we ever restart the Therapy Reimagined Conference, we’re going to have a workshop that is just Olympic training for therapists mental gymnastics, and rather than CE certificates, we’re going to give out medals. I’m actually really impressed that you went and you looked at things beyond just the numbered and lettered part of the ethics code. Many people forget that there’s a preamble and even in some of the ethics committee discussions that I sit in sometimes you don’t have to remind people of like, there’s a preamble that says some other stuff about this, too.
Katie Vernoy 23:54
Well, and I also grabbed the section intro from the avoiding harm one. Like I was all over that. I was like Curt always looks at the preambles in this section heads I’m going in, that’s where the good stuff is.
Curt Widhalm 24:05
Yes. Conveniently, you have left out part of you know, the five principles that really do set up an ethics code. You brought up non maleficence you got to a la croix of beneficiant in there. You know, labor of…
Katie Vernoy 24:29
You know I was picking out the ones that supported the the opposite. I wasn’t going to do all of the discrimination ones.
Curt Widhalm 24:38
Sure.
Katie Vernoy 24:39
Because you already had those.
Curt Widhalm 24:42
And I’m going to add in a little bit of discussion around justice and fidelity, which you did not speak to. Which are part of these five principles here. Now, justice, as defined in that ACA code is treating individuals equitably and fostering fairness and equality.
Katie Vernoy 25:00
Yes.
Curt Widhalm 25:02
So this means, above all else, setting everything all else in order to act ethically, we have to put ourselves in a position to treat our all clients equitably and fairly.
Katie Vernoy 25:15
Sure. And we’re human. And if we can identify, I’m not going to be able to do this with this particular client. That’s where we get, that’s where we get into this, whether it’s mental gymnastics, or a more complex ethical decision making process, I think I think that’s the juice. That’s the that’s the juicy part.
Curt Widhalm 25:37
And fidelity is honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships. So what I’m assuming is underneath your argument here is: what if a therapist can’t?
Katie Vernoy 25:56
Yeah.
Curt Widhalm 25:56
And what I’m saying is that these ethical principles are not just aspirational. But these are the base of what we do. We have to put ourselves into the position to be able to do these things.
Katie Vernoy 26:09
Sure.
Curt Widhalm 26:11
And so when somebody…
Katie Vernoy 26:13
We can’t serve every single client.
Curt Widhalm 26:14
When somebody cannot start to even begin approximating an idea of: How can I potentially do this? They are failing the very basics of our ethics codes.
Katie Vernoy 26:30
Okay.
Curt Widhalm 26:30
And if they cannot do that, that is A just a lazy approach to upholding the standards of our profession. And I know that we’re really, you know, trying to frame this as a ethics discussion here in this episode. But you know, this is where just by virtue of having a license and being trained to have a license for pre-licensees, having a license is a guarantee from the jurisdiction, who issues the license, that you at least know how to think about approaching new and novel situations. And so, for somebody to come in and just be like, you know, what, I refuse to see people who like seeded grapes, because that just goes against my sincerely held personal beliefs. By virtue of having a license, you have been theoretically taught in your graduate program, in your supervision, in your law and ethics classes, and all of the things that you would subject yourself to, like therapist podcasts on ethics, of here’s how I have to open up my mind to be able to approach a new and novel situation.
Katie Vernoy 27:46
And we went into some of the parts of this conversation in the I think the three episodes, we talked about firing clients and, and what, what that looks like. But just to kind of sum up some of the concerns there; I can, I can work as hard as I want on all of these, you know, the the main principles within the preamble, you know, or whatever it is, you know, whether it’s ACA ethics, code, CAMFT ethics, code, AAMFT ethics, whatever it is, there are a lot of these things are very, very similar. And I think that as a human, I’m going to do everything I can to be able to provide beneficence, you know, non malfeasance, you know, all of the things we just talked about. I’m going to do my best, and I am human. And there are limitations. And there are also times when working with someone who is chauvinistic, or who has some sort of belief system, or, or cultural orientation against me as a therapist, but want to work with me, so they can mess with me. You know, I think there’s that that element or wants to work on it directly, but I don’t have the bandwidth to do that work with them based on my own trauma history, or whatever it is, right? Just whatever. That doesn’t mean, I can’t practice as a therapist wholescale. It means that I can determine I am not the right therapist for this client. It just is, is it based on discrimination. This person has these characteristics, and I don’t work with those people. Is it an actual ethical decision making process and saying, I am not competent to work with this person? But, but I think you get into a pretty black and white discussion around this where it’s like you either do this or you should not be a therapist. And I think and I think you’d said that in one of the previous episodes, and it’s like, well, wait a second. There’s there’s a lot of gray area where therapists can do the best that they can, but potentially refer out in a way that without a really nice documented ethical decision making process looks like discrimination.
Curt Widhalm 30:03
Yes.
Katie Vernoy 30:03
And it may not be if they’ve actually documented a whole process. We can’t work with every single person. Like, as you we will do the best that we can to work with every single person. But I think we need to honor that we can’t become the perfect therapist or even potentially a competent therapist for every single client. I think the discrimination and protected classes I think are a little bit more obvious. And I think there’s, there’s a more of a push from our profession to try to be able to do that. But there’s also stuff like eating disorders or other things, which is I refer out at this level, and it’s a competence issue. And I think, when we try to sort some of those things out, eating disorders, you know, theoretically, are really just a competence area. But disability, if I don’t, if I don’t have lived experience, and I have not been trained to work with folks with disabilities, or disabled folks, I should probably refer out and that is a protected class.
Curt Widhalm 31:05
No, I think what what you’re describing here is years of experience, and kind of an internalized ethics decision making process that doesn’t go through as formally as I would love everybody to, you know, kind of document things out and to be able to point things out, but…
Katie Vernoy 31:29
We go through the very long process in our episode on dual relationships, and we also have a alternate ending where we go through it again, over on Patreon.
Curt Widhalm 31:40
But like CAMFT ethics, code 1.1, is, therapists make reasonable accommodations for people with physical disabilities.
Katie Vernoy 31:48
Sure.
Curt Widhalm 31:49
Full stop, like, this is not like…
Katie Vernoy 31:51
I’m not saying Do you have an elevator or not? I’m saying, do you understand if they’re coming in and saying, I’m having trouble, because I’m a disabled person, and I don’t know how to navigate the medical system and da da da da da. And it’s all issues surrounding disability. And you have none of that competence. That is a competence area, but still, you’re you’re potentially referring out a disabled person.
Curt Widhalm 32:17
You, as a licensee have the competence to be able to help people navigate systems. I mean, that’s, I think, what you’re what you’re doing, and this is where, you know, the proliferation of short form content about our profession, things like TikTok is almost like this game of telephone that we played, like as kids of like, we take these sound bites, and then somebody else takes a sound bite off of that and says, you know, Hey, did you know this thing is this feature of this other thing, and then some layperson takes it and says, Did you know that this is a diagnostic criteria for this thing? Like, you’re, the reason that you get frustrated by the longer discussions into these kinds of things is, it is a deeper, slower thinking process.
Katie Vernoy 33:05
Sure.
Curt Widhalm 33:05
That there are aspects of what you’re talking about, is right, in that if there are certain client needs that require a higher level of specialty and skill, like you said, eating disorders at a certain level thing; that is a client need. But up until that point, there is tons of common factors research in that level of training, level of knowledge of background skills, years of experience within working within a population. Most therapists have the skills and the abilities to work with most clients pretty effectively. But we…
Katie Vernoy 33:53
I think there are those who would disagree with that.
Curt Widhalm 33:56
And at the risk of telling those folks that they’re wrong, those folks are wrong. Those folks are picking and choosing how they go about their work. And this is part of why over the years, we changed the question at the beginning of our guest episodes of What do therapists do wrong about this? To: What are some things that therapists can pick up on other people’s mistakes so that way, they’re not making the same ones. It’s guided towards learning and being able to do these skills better. You know, if you’re sitting in your car, you only have like five minutes on your way to the office and you need to break our episodes up into like, a week because you know, you’re going back and forth to your office every day. Just you know, if you need to sit in the parking lot for an extra couple of minutes because you can’t wait to hear what Katie and Curt say next. Then, then use your seven minutes at a time. But this, this excuse of like this population makes me scared. I’m too busy. That reflects on all of us. And sure, there are times when it comes to capacity. I get you know phone calls of like, Hey, do you have any openings? And I say, not really. You know, I have a capacity limits?
Katie Vernoy 35:07
Yes.
Curt Widhalm 35:08
Um, and, you know, I know that you’re trying to get to a point of like, when is it values based versus when is it discriminatory versus when is it client needs? So going back to an eating disorder thing is like, alright, if this is a client who’s got some disordered eating, and like, you know, sometimes they just really get triggered by seeded grapes. Most of us have that ability to work with clients on managing anxiety and reactions to environmental stressors. If that same client is somebody who only eats seeded grapes, and is having really strong physical, you know, reactions and, you know, deficits. Those are things where that’s a client need. But if it’s like, hey, you know, what, just talking about seeded grapes triggers me as a therapist, I can’t see work with you at all. That’s discrimination.
Katie Vernoy 36:06
Sure. And I, I feel like that’s a simple answer. And there’s, there’s more complexity when we have real people in the room. And I think that what I’d like to get to not just like, hey, don’t be lazy or don’t, you know, don’t discriminate. I want to actually get down to how do we determine what is, what we should do when someone contacts us, they want to work with us in therapy. And they like seeded grapes, or they eat seeded grapes, or, or they don’t eat seeded grapes.
Curt Widhalm 36:36
They bring seeded grapes into the therapy room.
Katie Vernoy 36:37
And they spit them on the floor. I think it’s it’s something where…
Curt Widhalm 36:44
They crunch them in the background while you’re talking.
Katie Vernoy 36:48
I think the thing that I’m trying to sort out is How do we make these decisions? Because there are times when we will do harm if we work with someone who is not within our area of specialty, not with our in our area of lived experience, not within our area of of primary understanding of our profession. And there are times when we need to suck it up and take a take a training or consultation or those things. But but we, I don’t have unlimited time and unlimited limited resources to take 40 hour trainings for every client that decides they want to work with me. And so I think it’s this element of how do I make sure that I am working ethically, following all of the ethics codes, not just the non discrimination one or not just the non malfeasance or non not just the competence one? It’s that How do I take all of those things in an understanding way, and not just because hey, I don’t really want to learn how to work with somebody, but I want to do a good job. And I want to, I want to effectively use my time as a clinician to work with the folks I work with best. We’ve talked about niche and having folks self select, and we have a whole episode on Brand Called You and probably a bazillion other marketing episodes from long ago. But when someone still comes through and they say I want to work with you, and you really don’t feel like you can, can be the best therapist for them. I mean, some of it is it comes down to are there reasonable referrals? And I think we have episodes on refer out to like we’ve literally talked about this a lot. But there’s there’s this, this x this, this line to walk where it’s not just like, hey, I don’t want to work with men, I hate men. Men are the bane of my existence. So I’m just going to refer all men out. It’s, it’s more this particular, whether it’s characteristic, or presenting problem, or whatever it is, is something that I don’t think I can do a good job at. And so I want to, if that’s the presenting issue, and so I want to make sure that I’m doing a good job at connecting people to the correct person. And if it’s not me, not taking that client.
Curt Widhalm 39:03
I think that part of how you hear me talk about this is We should take all clients. And I’ll be the first one to say no, this isn’t not a push for you to take all clients.
Katie Vernoy 39:15
Okay.
Curt Widhalm 39:15
But I think this is again where the ethical discussion around this and pointing to 2012 article by David Kaplan “Ethical implications of a critical legal case for the counseling profession: Ward v. Wilbanks” and this was in the Journal of Counseling and Developments in 2014. And what Kaplan goes into is the parts of the ACA ethics code A 11, which is about values based referrals, termination and referral, and specifically getting into Julia Ward’s focus on A 11 B values within termination and referral. And this is ultimately what the appellate court ended up sending the case back to the District Court on. But what Kaplan points out is that A12 is about abandonment and client neglect. So right in the same part of the ethics codes, and so oftentimes ethics codes will be organized as far as these things are related or married together in some way. And what Kaplan goes on to talk about here is that when we just blanket refer out clients, or we hide behind things like sincerely held beliefs, that we’re at the risk of abandoning potential clients. That even if we haven’t seen them for a first session, if clients feel some sort of therapeutic relationship has been established, even in that referral process, and we tend to neglect them based on things like values, and those held beliefs we’re at risk of terminate, or we’re at risk of abandoning them. And so this is where Kaplan doesn’t go this strong, but this is wording that I would like to see in the ethics code spelled out, but what Kaplan does say is, we should look at referring out as the ethics of last resort.
Katie Vernoy 41:27
Okay. Explain that more.
Curt Widhalm 41:30
Because it can lead to perceived abandonment, counselors who drop clients, whenever potential values based conflicts arise, violate this prohibition against abandonment. The code recognizes that a client might suffer harm, if the counselor turns away at the very moment that the client’s most sensitive issues arise. And because of this risk, termination and/or referrals are matters of last resort to be handled on a case by case basis with the sensitivity to the facts specific to the client in question.
Katie Vernoy 42:03
So I like this as as a little bit more specific guidance. If I have someone come to me, and we start talking on the phone, and then we’re talking about referrals, and I think we have some episodes on referrals. It’s a little complex on when the relationship, the therapeutic relationship starts. But this is saying, if someone comes to you start talking to them on the phone, you have a responsibility not to abandon them. And so this is potentially one of the reasons therapists don’t answer their phone. But given that there’s this this element of if I can work with you, if we’ve started to develop even a minute rapport, based on the beginnings of a conversation, where I’m I’m saying, Hey, I potentially can see you, I can let’s start this process. And then something comes up that that’s like, oh, I have a strongly held belief, this may not work out. You don’t immediately go to Sorry, because you believe in seeded grapes I can’t work with you, because I don’t believe in seeded grapes and so I think this will be a conflict, at that moment. And and I’ve done this actually with eating disorders. So so I’m going to suggest a solution here and see what you think. At that moment, they say I strongly believe in seeded grapes. It’s a it’s a core factor in my life, I might say to do the veracity and the whole person therapist say, I’m seeing the the presenting problems as X. There’s also this other factor of seeded grapes. And I just want to let you know, as a therapist, I hold different beliefs about seeded grapes, do you think that would get in the way of our being able to work on the problem, which is x? What do you think?
Curt Widhalm 43:59
You’re like, 70% of the way there.
Katie Vernoy 44:01
Okay, so what else do I need to have there?
Curt Widhalm 44:04
If making a mutual decision with the client is the client decides, hey, you know what, you’re open and honest. And, you know, kind of holding the truthfulness about your experience and your ability to help me. You as the therapist are responsible for extending the action, which is let me help find some appropriate referrals.
Katie Vernoy 44:28
Well, I think, well, that was just the initial initial gambit, so to speak.
Curt Widhalm 44:33
Sure.
Katie Vernoy 44:33
If the client says you’ve been honest and open, and I don’t think it’ll be a problem, then you take the client, right? If the clients like, Hey, I get it. I have a really strong belief system around seeded grapes. I don’t need to talk to you about it, because it’s not really that relevant to problem X, that I’m coming in for therapy about. I’d like to see you. The therapist that has to see the client, right? And if the clients like Oh, I really need somebody that’s going to understand seeded grapes, it’s my whole life…
Katie Vernoy 45:03
Well, and…
Katie Vernoy 45:04
…it’s going into let me find you a nice warm referral to someone who also holds similar beliefs around seeded grapes.
Curt Widhalm 45:13
You know, if this was all stuff that was able to come out in the intake phone call, the intake, you know, sort of first connection sort of thing. I think that those clients who are going to identify that and make that as a big issue, you know, follow the brand called you sorts of things like…
Katie Vernoy 45:35
Yeah.
Curt Widhalm 45:35
You know, it’s been a while since I’ve had couples, a while since couples have been referred to me, you know why? It’s because I don’t actively advertise or make it known that, like, I’m better off working with a variety of other clients. My website doesn’t really, you know, put that out there, those kinds of things.
Katie Vernoy 46:00
Sure.
Curt Widhalm 46:01
I still hold that that is ethical, like, here’s who I’m really good at working with. When couples call me, hey, here, I’m able to work with couples, there are plenty of other therapists who can probably help you a whole lot better than me for some reason. Are you sure that you want to work with…?
Katie Vernoy 46:22
Well, no, at this point, if we go back to the decision, making…
Curt Widhalm 46:25
Sure.
Katie Vernoy 46:26
You are not taking clients.
Curt Widhalm 46:27
Well, but oftentimes, when this stuff does come out, is maybe not, maybe not in the paperwork, it’s later. And this is where that that relationship has already been established. And, you know, as much time as we would love for people to be able to put into only getting their niche clients in private practice. This is also an episode for people in public agencies and in graduate programs…
Katie Vernoy 46:54
And they don’t get to choose.
Curt Widhalm 46:55
And they don’t get to choose.
Katie Vernoy 46:56
Yeah.
Curt Widhalm 46:56
And this is where all of us are under the same professional umbrella.
Katie Vernoy 47:01
Yeah.
Curt Widhalm 47:03
And while it’s a little bit, you know, easier to be able to brand a practice, you know, of your own versus when you work for somebody else. Going through some of the stuff is learning how to deal with things as they come up. And, you know, it’s when those clients that you’ve worked with, you know, for several years before on something that is within your niche, and then they come back five years later, and they’re like, you know, what, I used to identify as a seeded grape, and now I’m identifying as a seedless grape. And I just really trust in the relationship and the help that you provided me before.
Katie Vernoy 47:43
Sure.
Curt Widhalm 47:45
Those are the kinds of things where yeah, you can still be open. Of here’s competence, you can make the decisions with the client on what you can provide. And the expectation is, and the parts that Julia Ward and all of these court cases have not handed in is all of the ethics codes of you then have an ethical responsibility to go and get better competency and get better consultations as part of this. And it is something that is a potentially an investment. And, you know, you might want to be able to limit some of this stuff. But you do have an ethical obligation to go and learn more with emerging populations, whether and emerging parts of your practice, whether those are parts of your practice that you are fully moving into on your own. Or if it’s something that’s thrust upon you by a client unexpectedly.
Katie Vernoy 48:42
I feel like what you’re talking about has a lot of relevance to folks in private practice. To a certain extent, we can identify what clients we take and not take mostly around kind of the funnel, so to speak. You know, networking with referral sources, telling them who we work best with, making sure that our website is very clear on who we work best with, and, and potentially trying to, at the beginning of the process, have some of these open conversations and determine with the client Am I the best fit for you here? Like really digging into that and doing an assessment on fit from the very beginning, and making sure that the client is taken care of in the best way possible. But for folks in public mental health or working in group practices or things where you do not choose your own clients. I think that this potentially is helpful because we’re saying, figure out how to work with all the clients. But it’s also potentially really frustrating. Because I look at especially poorly funded community centers that have, that are barely paying their clinicians you know, hopefully they are paying them. But they’re barely paying their new clinicians to do this work, they’re oftentimes stacking the caseloads very big, and not giving them any, you know, any agency on who they see how they set up their schedule, all of those things. And this is adding an additional burden of, and I have to figure out how to work with these clients. And so I want to pop back into one of the things that you said before, which is the common factors element, and being able to show up as a therapist and a human and and coming from a place of curiosity even if you don’t know about their particular brand of seeded grapes or seedless grapes. You can still be a human in a relationship. And I think that goes to, if we dig deeply into the common factors and show up in that way, I think we can work with a lot of clients and not do harm and potentially do good. I think it’s taking that extended level to get more training, to get more consultation. Sometimes that’s not available to folks in these really overworked, underfunded centers. And so is that sufficient? Really digging into the therapeutic relationship and showing up in the best way that you can and potentially doing some Google research or whatever you can do that that gives you a little bit more context, but to potentially working together with a client to be the best therapist for them? If that’s what you’ve got.
Curt Widhalm 51:31
It costs nothing to sit in a room with a client and listen to them without rolling your eyes, without sighing at things that make you uncomfortable, to be able to have a genuine, positive human relationship with somebody.
Katie Vernoy 51:53
Yeah, well, I mean, it costs emotional and mental load. But I think those are the things that we’re signing up for. And hopefully, we have some autonomy, which, again, folks that are underworked, are overworked and underpaid, may not have all of the mental and emotional load that they need for gigantic case loads. So I just want to acknowledge that this could be hard, but I think it is something where if we can learn that, if and not even if. We need to learn that because that is what we’re being tasked to do. I mean, that I could get my head around, I think it’s that that element of you have to have all of this competence, and all of this extra training and all that stuff. And it’s like, yeah, but I can’t do it all at once.
Curt Widhalm 52:40
Sure. And I’ll totally normalize that as part of the learning process. But it’s something where it’s an ethical responsibility. It’s a practical responsibility. And I think that this is something that tends to contribute, especially for early career clinicians and students into some of that imposter syndrome thing is the risk of taking kind of this approach of, you know, kind of what you’re talking about, I’m only able to work with those things that I’m competent at. And unless I have all of these trainings and stuff, I’m not competent at things.
Katie Vernoy 53:15
Yeah.
Curt Widhalm 53:16
That leads to impostor syndrome, or, you know, kind of this, I have to be perfect for everybody. Where there is that shade of gray that you’re looking for, which is alright, I’m gonna show up perfectly imperfect. I’m going to be in the process with my clients. I’m going to be as the ethics codes point out, truthful about where I’m at in my experience with these things. Because the opposite is also true. How many people do we see who go to every single training but have no practical experience of being able to apply things that are potentially just as ineffective if not more?
Katie Vernoy 53:55
Yeah.
Curt Widhalm 53:56
And so there’s, there’s a space within there, which is, being honest with clients of here is a now emerging part of my practice. Realistically, I, I have the ability to, you know, look into this a little bit at a time and go on this journey along with you. I may not be 70 steps ahead of you, like I am with other populations that I’m really comfortable with. But I think that here’s a great social media question for us to put out this week, but it’s How many hours in a given week do you put towards learning about new things about clients that you work with or potentially work with? Because a couple of weeks ago, we just had, you know, Maureen Werrbach on and we had a great social media response when, you know, we did the poll, quote, as far as like every business owner should put an hour a week just looking at the emergence of where their business is going. That’s not part of our or ethics code, but everybody, you know, yay, you know, let’s do that. But is I have a concern that once we get to a level of comfort, we stop actively going out and learning and being able to actively apply the things that we’re learning with clients. And I think…
Katie Vernoy 55:21
I want to, I want to address that, though, because I think that my perspective on it is not that people aren’t learning. It’s that they’re learning more about the things they already know. And so there, they are digging deeply into IFS, EMDR, you know, whatever it is, they’re going deeply into either modalities, or they’re going deeply into their niche specialization. And I think some of that’s good, but I think what you’re really saying is, is that folks are not taking the time to research clients that are unfamiliar to them, or new to them in some way. And so I think it’s, it’s something where being able to have that capacity to identify, this is an interesting new client that has an interesting new characteristic, a new take on seeded grapes. I think being able to say, Hey, I’m gonna do some research there, that’s part of my responsibility, is great. We will go to all of the episodes, I’ll even just put the burnout episodes or whatever it is, this requires you not to be burned out. And it requires you to be doing your own work in some ways, whatever that looks like. Because I, in my head, the thing we we’ve skated around and not really addressed directly, are the folks who discriminate people who are privileged, because of their own, you know, kind of marginalization by those by that class of folks. And I think that there is legitimate harm that they are experiencing and have experienced in their lives. And they may be discriminating, you know, I think you we talked about it pre it’s like they may be punching up, so to speak. But there’s still this need to be able to show up for the client that comes to your door, or your phone call or your zoom screen or whatever. And so I think it’s that that element of, we need to be able to manage our own responses and our own emotions. And I think that there isn’t, there isn’t a space beyond which, or a line of past where we can do that competently. And we need to know what that is. And so I don’t know if we want to take that part of the conversation. But I think the ethics codes are saying, be emotionally capable of working with any person that comes to you. And I’m saying I don’t know that that’s reasonable. And yet, whether it’s an aspiration, or a requirement that we we get ourselves to that place, I think we need to, we need to be at least aware of where we sit, where we sit in the current moment.
Curt Widhalm 57:58
I’m glad that you’re pointing out this, you know, punching up sort of thing here. Because you know, in the CAMFT code of ethics 1.1 is we don’t discriminate based on all of these kinds of things. And that includes socioeconomic status. You know…
Katie Vernoy 58:15
We have to see rich clients, guys, we can’t we can’t discriminate.
Curt Widhalm 58:20
One of the situations where you don’t eat the rich, but it separates out and it’s it’s a separate, it’s one of those neighbor ethics codes, where we also understand that historical prejudices against some of these populations. Again, nobody is saying, you know, white sis het men are going to, you know, have historical prejudices against them. But they don’t, they don’t apply in 1.2. Yeah, we can’t discriminate against them based on 1.1. Yeah, exactly. So it’s the extra care that we put in understanding those from traditionally marginalized, protected groups. But that’s still trumped by the one right before it, which is we still don’t discriminate against anybody based on these characteristics.
Katie Vernoy 59:15
Yeah. And just to clarify, because I realized we were almost talking in shorthand. We can’t base, we can’t discriminate based on any gender, any gender not just we can’t discriminate against marginalized gender identities we…
Curt Widhalm 59:28
Correct. Yes.
Katie Vernoy 59:29
…can’t discriminate against any associated socio economic class, not just we can’t discriminate against folks who are poor. And so I think it’s it’s being able to say, hey, wait a second, if I have these issues, with sis het white billionaires, if they come to my door, I still have to see them.
Curt Widhalm 59:53
If the therapeutic relationship has the beginning of sprinklings of being established, you need to go through a very resolute decision making process. Because again, all of this stuff comes from reducing your liability.
Katie Vernoy 1:00:13
Okay.
Curt Widhalm 1:00:14
You know if, as an ethics committee, we are looking at something that smells like discrimination, it looks like discrimination. And there’s a really thoughtful process that went into, you know, what I had 31 clients in my private practice, I couldn’t fit in one more client who needs three sessions a week, because they, you know, are presenting with really high risk, suicidal type behavior. I made solid referrals, I introduced this client to other therapists, and they were, you know, really focused on working with me, because I’m awesome.
Katie Vernoy 1:00:55
Which is, why I have 31 clients?
Curt Widhalm 1:00:57
Right. That looks a little bit different, rather than, you know, if a client is complaining and says, You know what, that therapist rejected me because I like seeded grapes. So this is where it seems laborious to really be able to go in and document all of this stuff. But having that protects you. And it’s when you don’t go through that good decision making process, and you don’t document this kind of stuff you’re opening yourself up to liability.
Katie Vernoy 1:01:36
Sure. Another comment that I think is worth exploring a little bit. And I know that we’re kind of at the end of our time here, but it is your decision making process and/or your decision making process in, in collaboration with your client. It’s not going to a Facebook group and having people tell you, you have to refer out because you don’t have lived experience, or you have to refer out because you can’t be an ethical provider for them, or you have to refer out because you are of a different, you know, orientation to seeded grapes. Like I think you have to make that decision with your client. You have the full conversation or you have the full decision making process. But it can’t be unduly influenced by folks who don’t have all of the facts. Which you cannot get from a Facebook group. If you need guidance, seek consultation appropriately, and potentially even document that consultation because I think it’s so easy to say Well, you don’t know that type of client, you are going to defacto harm them. Refer out.
Curt Widhalm 1:02:48
Yes. Don’t don’t participate in therapists games of telephone.
Katie Vernoy 1:02:55
Yes. Well, I want to I want to add a little bit to our summary here too, because I think that there’s there’s a clarification that I think we got to that I want to just say is more specifically: it is discrimination when you have no thought and you refer out based on a…
Curt Widhalm 1:03:14
Prejudice and bias. Yeah.
Katie Vernoy 1:03:17
Yeah, some sort of bias or are related to a protected class that there’s there’s no thought to it. It can be discrimination, when you don’t go deep enough into that decision making. And it’s, well I don’t think I can help you. So I’m gonna refer you out. There needs to be deeper thought. There needs to be an understanding of How do I make this decision? And again, I was joking earlier, but we do have, I think, some pretty good episodes on on ethical decision making, or I guess an episode around dual relationships that I think really shows the level of depth that can be very helpful, especially when you’re in a place that you’re not quite sure how to how to think it through deeply enough and you’re concerned. Seek consultation, keep learning and show up as a therapist using, you know, kind of the common factors principles to be helpful, at least to a certain extent. I think the way that we avoid having some of these decisions land in our lap is being very clear in all of our marketing materials and all of the things on who we serve best. And folks will hopefully self select out if our deeply held beliefs are misaligned with theirs. And so it speaks to if you have deeply held beliefs that you think may be important for clients to know put them on your website and make sure they’re aware of that. I think the other element is really do a good initial phone call and and not just talk about how you work but get to know the person and the client a little bit so that you can understand Is it? Is it discrimination? I just, I didn’t really want to work with a client like this. Is it competence? This, this person has a pretty specific need that I don’t think I can fulfill without, you know, a year of training? And so, you know, I can refer out? And is it a relationship that is worth pursuing? I think if we can do some of that really good assessment up front, I think it helps us to be able to, to not get into the situation where six months in, all of a sudden, we find that we’re in deep conflict with our client and not not able to work with them. And so I think it’s it’s something where there’s, there’s still nuance, but understanding your competence, includes working with a human being. Your specialty, and expertise may be very, very focused. And so if that’s the case, make it clear. And discrimination isn’t, oh, I don’t work with some people, because they don’t fall within my niche. It’s I just don’t work with these people. And I don’t have a thoughtful process behind how I choose who I serve and who I do not. And when you can’t serve someone who’s called you, you need to do really good referrals, which I think we do have a full episode on that. So…
Curt Widhalm 1:06:16
Yes.
Katie Vernoy 1:06:16
…in the show notes.
Curt Widhalm 1:06:19
You can find our references and show notes over at mtsgpodcast.com. And make sure that you join our Facebook group where we don’t play games of telephone there. It’s the Modern Therapist Group. Follow us on our social media, and consider becoming a patron for all of the wonderful background information that we put out. And, you know, we do cite our patrons every so often in our episodes and create little carve outs for them. And until next time, I’m Curt Widhalm with Katie Vernoy.
Katie Vernoy 1:06:53
Just a quick reminder, if you’d like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.
Curt Widhalm 1:07:08
Once again, that’s moderntherapistcommunity.com
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