How to Fire Your Clients (Ethically)
Curt and Katie chat about how to appropriately terminate with clients when icky situations arise. We explore how therapists can develop an ethical decision-making process to protect themselves against possible complaints to ethics boards. We also talk about how privilege plays a role in icky terminations and how therapists can work to balance their safety and self-care with their responsibilities.
It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.
Transcript
Click here to scroll to the podcast transcript.
In this episode we talk about:
- How ethics are discussed in social media groups (ethical concerns vs. I don’t like this)
- When we can terminate with clients, why can we do it, when we cannot terminate with clients, and what our responsibilities are in these situations.
- How therapist’s personal feelings can influence premature terminations and the problems this can lead to (e.g., client abandonment, continuity of care).
- Feelings that arise for both the therapist and client when icky terminations happen.
- How ethics committees think about complaints and disciplinary actions.
- Developing an ethical decision-making process that demonstrates professionalism.
- Explore how therapists are held to a higher standard than the general public.
- Discuss how privilege (or lack thereof) impacts perceptions professionalism.
- How to maintain professional standards when your safety is at risk.
- Developing plans for possible icky terminations.
- We look at how many therapists are actually reported to ethics boards and how this information is unhelpful.
- Managing racist, homophobic, sexist, etc. comments in session and taking care of yourself.
- Explore how the structure of ethics committees create barriers to therapists being their authentic self, while also needing these committees to protect the field.
- Balancing therapist safety and self-care with therapist responsibilities.
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Resources mentioned:
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CPH Article: Duty to the Patient – Termination of Treatment and Understanding Your Patient
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Who we are:
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, 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 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. 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
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Full Transcript (autogenerated):
Curt Widhalm 00:00
This episode of the Modern Therapist Survival Guide is sponsored by Buying Time,
Katie Vernoy 00:04
Buying Time has a full team of virtual assistants with a wide variety of skill sets to support your business. from basic admin support customer service and email management to marketing and bookkeeping, they’ve got you covered. Don’t know where to start, check out the system’s inventory checklists, which helps business owners figure out what they don’t want to do anymore and get those delegated ASAP. You can find that checklist at buyingtimellc.com/systemstashchecklist
Curt Widhalm 00:31
Listen at the end of the episode for more information.
Announcer 00:34
You’re listening to the Modern Therapist 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 00:49
Welcome back modern therapists. This is the Modern Therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the pocket about all things therapists the things that we like to do things that we don’t like to do. And Katie, and I spend some time in some of the various therapists, Facebook groups, online groups and stuff. And we were inspired by a post that was put somewhat recently about what we’re just going to classify as achy terminations. And long time ago, we had done a podcast episode that at least off the top of our minds is about positive terminations and the termination process. And Katie and I have been talking about the roles of When can we terminate with clients? Why can we do it? Why can we not do it? What our responsibilities are in these situations, and especially in some of the discussions that we see in some of these groups that really throw out a lot of, hey, that’s unethical sort of things. We have a whole episode on that’s on ethical, but I don’t actually see a lot of engagement in an ethical decision making process in the statements. And so therefore, that’s unethical just kind of stands in for I don’t like that.
Katie Vernoy 02:14
Yeah.
Curt Widhalm 02:15
So a lot of the questions that we’re trying to address in this episode is, when can our feelings kind of lead to us prematurely ending services? And what are our responsibilities in doing so?
Katie Vernoy 02:30
The question around, quote, unquote, premature termination, as far as the treatment standard, the client has not completed treatment, or finished services with you, they don’t want to finish with you. I think that’s always challenging, because there’s a lot of different reasons in my past that I’ve had to have these premature terminations, there have been shifting programs, I moved from one program to the next. And I had to terminate and transfer a client to a different therapist, I left an agency, I went off an insurance panel, I felt like I was not an effective therapist for someone. And I think most of the time with these quote unquote, icky terminations, I was feeling kind of situated in a place of discomfort, but not I never felt threatened. I never felt like it was something that was too hard for me to navigate. But it was something where I had to make sure that I was considering the client trying to process the termination with them, link them appropriately, and then move on. It’s uncomfortable. Oftentimes, clients are upset, they may feel betrayed or abandoned. But I think the the true thing when we get to ethics is about whether in fact, we actually are abandoning them or doing what we need to do in order to get them situated with their next treatment situation.
Curt Widhalm 04:01
And so a lot of these questions are going to come up around things like violence either directed towards the therapist situations where the therapist feels threatened, whether it’s a direct threat, whether it’s kind of more just kind of course language that isn’t necessarily directed at the therapist, we see this in racist comments made by clients, homophobic clients, against therapists who may come from those communities themselves. And the insight that I can really offer on this is having sat through ethics committee meetings as a ethics committee member is it helps to know how ethics committees think of these things, for full transparency purposes and talking about my role in this not speaking on behalf of the camp ethics committee on which I said, but what I can talk about is the process of how we would look at these things and ethics committees. Look at ethics complaints. So asking first and foremost in these situations is, is this ethical for me to do? might not be the right question to start with the right question to start with is how would I ethically do this? And this goes back to that ethical decision making process that I mentioned at the top of the show. And ethical decision making process is look at your ethics codes and see which ethics apply to the particular situation that you’re in. Because that’s what the ethics committees are going to do. When it comes to things like termination, we’re going to look at things like, Is this an abandonment situation? Is this a situation where the therapist took reasonable steps in order to help the client secure other services? Is this something where it’s the therapist just making their own personal values, something that is bigger than the therapeutic process that has already been agreed to? And how did they go about instituting the actions that they decided from there? So when we see questions, or when I see questions in some of these groups about is this ethical for me to do? My first response is really, how are you applying your relevant ethics code to the particular situation that you’re asking about, because that’s ultimately how an ethics committee is going to evaluate this.
Katie Vernoy 06:27
So if we’re looking at someone choosing to terminate a client, because they feel threatened by the client, so let’s just go there, whether it’s a physical threat, a verbal threat, I’ve had colleagues who were stopped. I mean, there’s there’s a lot of different ways where there’s been actual physical violence, threats of violence, and just kind of threats of identity. So let’s be very broad, because I think that that’s helpful. What are the things that we actually have to look at? Because I hear kind of abandonment, and maybe continuity of care? But what is my responsibility as someone who is feeling threatened? In that situation? Like, what do I actually have to do? When I’m in a place of feeling threatened?
Curt Widhalm 07:15
The shortest and most distinct answer I can give you is terminate appropriately. Okay. Now, this is where your reasons for feeling the way that you do might necessitate a number of different actions here. But I’m going to point to a article from Richard Leslie over at CPH insurance on their avoiding viability blog. The original part of this that I’m citing right now comes from a 2005 article from him that was updated a couple of times after that. But what Richard points out is if the termination process is not properly carried out, the attempt to end the professional relationship with the client can constitute or be argued as an abandonment of that client, this could lead to lawsuits, complaints to your licensing boards, complaints to ethics committees. And well patients generally have a right to terminate at any time. therapists do not. Now that’s not saying you never have these options, what it’s saying is that you as a professional, are held to a higher standard through this process. So in situations like what you’re describing is that yeah, if a client brings a gun to session, and is pointing it at you and making threats, save your life, like you know, in those moments like do what is do what is necessary and given and document the hell out of that in case you are being investigated. But that is providing the appropriate kind of thoughts for the ethics committee or the disciplinary boards to be able to look at, okay, these are the circumstances that make sense. Now, outside of those incredibly rare situations like that, where it’s probably just more uncomfortable sorts of things of saying mean things about you or the communities that you’re from, even if they are to a level that is seen and agreed upon by many people as a very heightened and emotionally driven and triggering sort of rhetoric. Not talking about the same level of action here. And this is where our professionality is what separates us from those non professionals is that we are expected to engage in a thoughtful process of what we do that is best for the client regarding these situations.
Katie Vernoy 09:52
The caution I am feeling in the what you’re talking about is that there is a very different perception of what happened from someone who sits in privilege versus someone who sets in a number of different marginalized identities. I think there’s also a lot of squishiness on what is truly threatening. I’ve had clients stand over me and say mean things. As a reasonably large woman, I don’t necessarily feel completely physically overwhelmed by that. But I also know as a woman, I’m oftentimes feeling more physically threatened than a man might feel in that same situation. And so who determines what is truly a risk or truly dangerous, because there’s so much that could be threatening or dangerous that trying to document it appropriately, or trying to explain while the why the hair on the back of my neck is, is up, because I’m feeling very threatened? To me, it seems like, as a clinician, am I able to make that assessment? Or am I going to be held to some standard of someone who doesn’t feel threatened by somebody saying something to me,
Curt Widhalm 11:04
rather than taking this from the individual about the profession as what would a reasonable therapist do in the same situation? Now, if there’s questions of safety involved, most reasonable therapists are going to look at that in a way of Yeah, this is a client who’s showing that they are not able to be physically safe in this kind of work environments, that leads to the appropriate termination process.
Katie Vernoy 11:35
So I don’t necessarily have to keep seeing the client and I don’t necessarily have to fully justify 27 times over that I’m feeling threatened if someone is similarly situated in the world, to me as a therapist would have a similar response would, and would determine that this client was not appropriate to continue in treatment, I can’t terminate the client, I cannot abandon them. Correct. And so you keep saying appropriately terminate. And that feels like it could be three referrals and off you go, or it could be a full processing of the termination. Neither of those extremes feel appropriate when I’m feeling threatened. Because one feels like abandonment, one feels like self abandonment, that I’m I’m sacrificing myself and holding myself to a standard of having this conversation with a client that I feel threatened by. So what do I actually have to do to appropriately terminate someone who I feel threatened by who I do not want to see again,
Curt Widhalm 12:37
you need to do what’s best for the client. And given the particulars of the situation that you’re in is going to dictate what those actions are. Now, when we have generally high functioning clients who are moving to another jurisdiction, or if we’re kind of leaving a practice and retiring, moving on someplace else, and this is a client who may or may not want to start services with somebody else, and appropriate sort of action with them is, hey, here’s three referrals in case you’re interested, I think these people kind of work like me, you might respond well to them. That’s an appropriate thing in that situation. And at the basis of your question is looking for a universal answer to a very nuanced set of different sets of classes. And as far as the topic of this episode goes, his might not be appropriate enough here, in that, for whatever reason, a client like this may be in such a heightened state that just providing them with three names might not be enough for them to actually get the services that they need. And this is where it is important for you as a therapist in these situations to document your reasoning for taking the actions that you have, because that is going to give whatever investigatory committee the insight into the thought process that you’re going through. If a client’s saying a bunch of racist or sexist or homophobic stuff to a person representing one of those communities. Yeah, I validate any therapists feelings in that situation of, Hey, this is really uncomfortable for me. I don’t think that I can benefit this client. I’ve expressed my views of this is how it affects people from this community. Clients escalated their rhetoric after I shared how my personal values might be affecting our process going forward. And I determined that I cannot serve this client because they’re not going to respond to the types of interventions that I’m providing as a representative of that community. Therefore explain that to them. And I gave them three names of people that they might respond to. that’s inappropriate termination.
Katie Vernoy 14:58
Okay. What if I decide after I get done with a session? I can’t see this client again, I can’t talk to this client again. Maybe I was I was in fight or flight in the session, feeling overwhelmed, feeling threatened? How do I do an appropriate termination in that way, because sending an email with three names, doesn’t feel like it’s enough,
Curt Widhalm 15:21
nor would I have that conversation with them through an email now, okay? appropriate termination, this is easy to imagine in an agency type setting. Sure. Now, if there’s a extremely triggering client to you as a therapist in an agency, appropriate termination, doesn’t necessarily have to come from you as an individual, that in an agency, it’s very easy to imagine somebody else from the agency being a agent on your behalf, who takes care of these very same steps for you. Yeah, I’ll be your coworker here and go to this particular client is a client of the agency and say, Hey, Katie is no longer able to do services with you, based on what she’s provided about this situation, she feels that it’s your best benefit to reach out to one of these three following therapists or based on kind of a treatment team sort of decision, you’re going to either be reassigned to this therapist, or you’re going to that is a warm process that is handed off. I think a lot of people have difficulties in imagining this is when you’re a solo practitioner, and you don’t necessarily have somebody else to rely on in this way. But appropriate terminations can still involve having somebody act as an agent on your behalf, preferably a trusted licensed colleague who’s working with you somebody that you would have covering your practice on vacation, that there are standards within our profession that do allow for other people to act on our behalf in certain situations. Having somebody do this, if it is not in the benefit of the client for you to do this, or if it’s not something that you’re able to professionally fulfill your role in that way. An appropriate termination is having somebody act on your behalf in this way, doing basically the same kind of steps for you.
Katie Vernoy 17:20
So as you’re talking about it, it makes sense because I did that a lot as a supervisor, manager, director in an agency as I had to have those conversations, I reassigned cases I did all those things. So that totally makes sense. And trying to translate it to private practice and having an agent, someone that might cover your practice. When you’re on vacation. What are the confidentiality issues here? Because I think, here’s someone that’s out of nowhere, their therapist saying, I can’t work with you anymore, someone they don’t know, comes and says, Hey, Katie, can’t work with you anymore. Here. I’m here to help you find a new therapist. I mean, how do you not get in trouble both for abandonment and breaking confidentiality? Like how do you actually do this?
Curt Widhalm 18:10
And your best case and future forward thinking for yourself, you would probably want to add something to your informed consent about situations in which you’re incapacitated or otherwise unable to fulfill your professional roles. that a person who has a mental health license may be acting on your behalf, that should alleviate these particular questions, especially if people can provide fully informed consent in those situations.
Katie Vernoy 18:41
Sure. Okay, so you want to make sure that there’s informed consent, you want to make sure that you have an agent that you trust that you can accomplish these things? That feels okay to me, because it’s not relying on me as a therapist, needing to put myself at risk, either emotionally or physically, as long as I’m doing the things that I need to do for my clients as a professional.
Curt Widhalm 19:08
Sure.
Katie Vernoy 19:09
Okay. So when we’re looking at these icky terminations, I mean, what really is the risk? Do we have a sense of how often and maybe this is going down a rabbit hole? But do we have a sense of how often clients actually report folks to the ethics committees or the consumer protection bodies around being abandoned by quote unquote, bad therapists that that won’t treat them?
Curt Widhalm 19:38
So I think looking at those kind of gross numbers of these kinds of complaints is not helpful. Okay, the reality is, a lot of these kinds of things don’t end up getting reported by clients in the first place. That is not your protection. That is not your ethical or legal protection. Because what is going to happen is that if you are one of those cases that does get reported, this is the evaluation process that you were going to be subjected to. and ethical decision making probably involves thinking about these things, well beforehand, I can easily sit here from my cisgendered, white male hetero privilege, and tell everybody how they should act. But I’m specifically talking about how ethics committees or disciplinary committees would evaluate some of these decisions. So please don’t shoot the messenger on this kind of thing. But people sitting on those committees would love, if you have some sort of thought process that you’ve laid out, at the beginning of your practice of, like I said, putting something in your informed consent about somebody may end up at some point needing to have to act professionally on my behalf. Things like having some sort of documentation manuals that you’ve set for yourself, as far as if I’m coming from a community that is a target of hate speech, or you know, is reasonably predictive of being targeted by people who are seeking out services and might end up targeting me because of these things, that you’re going to have a plan in place of how you’re going to respond to those clients. These are things that are that level of professionalism that we are held to that higher standard to that allows us to engage in what many people in these Facebook groups are talking about, which is, you know, take care of yourself first. Taking care of yourself first is having the foresight of these are reasonable situations that I might end up in, in my role as a professional, and here’s how I’m going to take care of them. If I do ever run into those.
Katie Vernoy 22:00
That makes sense. And I feel like there’s a systemic issue that we can’t solve right now. But I feel like there’s a nod to professionalism, a nod to being able to behave appropriately and do those things. And you know, as a clinician, I do want to make sure that I’m doing things correctly, I don’t know how to formulate what my thought is. So I’m going to talk a little bit and we’ll see if it gets anywhere helpful. But there are criticisms that I’ve heard that I am still sitting in around our profession being too formal or too structured in this way that doesn’t allow for real people to actually engage in it. That really supports folks who sit in privilege to be able to be therapists and folks who don’t have to conform to these standards, that may be excruciatingly hard to accomplish. Now, what you’re describing is planning ahead saying, Hey, I’m going to have horrible things happen to me as a therapist, how do I plan to take care of myself in those situations, whether it’s just strategic planning or feeling like I have to put on armor because of the specific things that make me, me? I mean, I think we can argue either way. But is there something we can do as a profession? And I really don’t know the answer this. So I’m just asking this kind of openly. Is there something we can do as a profession that helps clinicians to feel safer within it?
Curt Widhalm 23:40
I think the at least part of the question, and maybe to put it in more succinct words is the way that professionalism has been weaponized against marginalized communities in the past. Yes, yes. And is in thank you for pointing out that my intention of using professionalism here is about having foresight, not necessarily about Yeah, wearing a suit and tie or appropriate professional dress to the office and being proper again. Yeah. As a modern therapist, I encourage you to go and let your freak flag fly. Alongside having this professional foresight part of taking care of ourselves as therapists is looking at those reasonably identifiable situations that we may get ourselves into trouble with clients, and to develop safety plans around that. We as a profession, professionals within our profession, tend to have clients act out against us physically at about the same rate as law enforcement do physically. I mean, this is a place where it can and it does happen, and it’s an incredibly privileged place. come from thinking that we can have practices that we’re not going to be working with people who have mental health issues that are always going to be safe around us. And therefore, having the foresight to plan for those situations is where the level of professionalism comes in. That is where the clinician safety comes in of making this a better place for our clinicians is being able to take the collective knowledge of all of our community and being able to have the conversations of make plans, have conversations of follow through on those plans, don’t think that you’re never going to run into them be reasonable about the types of people that we work with, document appropriately.
Katie Vernoy 25:47
So, in starting to get towards wrapping up, I think there’s a couple of different episodes, and we’ll link to them in the show notes, but one of them is therapist safety. That was one that we did that was about true physical violence that led to the death of colleagues in Northern California, I think that there’s an importance to understand how we protect ourselves as individuals, as clinicians, I think there’s an importance in making sure that to the best of our ability, that we’re taking care of our responsibilities as a clinician. And the thing that I want to just highlight again, is that may not be putting ourselves back into the fray, it could be having a supervisor or a colleague, an agent of some sort, make sure that your professional responsibilities are taken care of. And that feels okay with me. I think it’s, it’s something where when these conversations go to a place of judging someone’s response to a client, going to judging a person’s own felt sense of the level of threat, that’s where I get very protective of therapists, I understand that we are held to a different standard. I don’t know if that’s okay. 100% of the time.
Curt Widhalm 27:07
And that’s where, for us to keep a level of professionalism, and being able to rely on things like our ethics committees to help make those case by case situations, actually does help protect us more than the absence of them. Yeah, what I mean by that is that having ethics people review these situations as they come up, is at least people from a shared background and a institutional knowledge of working in mental health, that allows for the very nuanced discussions and decision making process and whether or not something’s unethical or not. In the absence of that, what happens is it becomes government regulated, and it becomes legislatively mandated, and those evaluations are not necessarily done by people who have the same kinds of work experience that you do. Yeah. And so the squishiness of this, sometimes it feels kind of bad, but ultimately, there’s more good created out of this because the people who are ultimately making the decision on whether your actions are ethical and representative of the profession, or people who’ve likely been there themselves.
Katie Vernoy 28:28
I think we’ve said what we can.
Curt Widhalm 28:32
We will include links to these past episodes and relevant articles in our show notes. You can find those at MTSGpodcast.com. And check out the therapy reimagined conference, we’ve got that coming up at the end of September – September 23 24th 25th. Live in Los Angeles and virtually wherever you may be if you can’t make it out to hang out with us in person. And until next time. I’m Curt Widhalm with Katie Vernoy.
Katie Vernoy 29:02
Thanks again to our sponsor, Buying Time
Curt Widhalm 29:05
Buying Time VA supports businesses by managing email communications, CRM or automation systems, website admin and hosting email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve by ensuring that your back office runs smoothly for the full team of VAs gives the opportunity to hire for one role and get multiple areas of support. There’s no reason to be overwhelmed with running your business with this solution available.
Katie Vernoy 29:34
Book a consultation to see where and how you can get started getting the support you need. That’s buyingtimellc.com/book-consultation once again, buyingtimellc.com/book-consultation.
Announcer 29:50
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