Liability Hot Potato: Defensive Therapy practices that give clients inadequate care
Curt and Katie chat about defensive therapy practices. We talk about how therapists avoid liability by practicing defensively, which can harm our clients. We look at common defensive therapy practices, like refusing to see clients with certain types of risk or too quickly hospitalizing someone. We explore the risks to our clients when we practice this way and how we can navigate risk to avoid practicing defensively. This is a continuing education podcourse.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we talk about therapists minimizing their own liability without benefiting their clients
Therapists facing difficult decisions in therapeutic treatment are presented with the competing tasks of providing quality care to clients while also trying to minimize their legal risks. This can lead to therapists who may choose courses of action that do not benefit clients while doing things to protect the therapist. This podcourse explores the types of defensive practices that therapists take, how to recognize them, what steps can be done to protect therapists, and how to maximize client outcomes.
What are defensive therapy practices?
“This [anxiety around law and ethics] leads a lot into this lawyer phobia sort of thing. Like: if I can just avoid all of the lawyers, I can avoid all of the subpoenas, I can just stay within this really safe bubble of things that I can treat really well, then I don’t have to put myself at risk for anything. And this ends up being things that over time, have – you know, through the therapist game of telephone – [ended] up just being this contagious fear that we all get left with” – Curt Widhalm, LMFT
- Actions taken by a therapist that don’t benefit the client, but are done to protect the legal liability of the therapist
- Avoidant versus Assurant defensive therapy practices
- Responding to very scary law and ethics classes
- Avoiding lawyers and subpoenas
What are examples of Defensive Therapy practices?
- Avoidant: Avoiding talking about anything that is even related to things outside of our scope of practice (e.g., medical or legal advice); refusing to see clients with specific types of risk
- Assurant: Sending clients to the hospital quickly based on risk rather than on treatment efficacy, over-reporting abuse and engaging clients with systems
- Therapists are employing defensive therapy practices when making sure to shift liability elsewhere
How do I navigate the risk that often leads to defensive therapy practices?
“We have to sit in the gray a bit… you talk about these prescriptive [practices] and they sound good, but I feel like there’s a lot of interpretation, I think there’s a lot of knowledge that is required from therapists. And uncertainty that we have to sit with as we’re going through these processes.” – Katie Vernoy, LMFT
- Make clear the limitations on your knowledge, but respond to questions and needs in the best way you can, referring to experts as appropriate
- Prescriptive Assurant practices (taking action based on laws, rules, and/or ethical decision-making)
- Documentation of ethical decision-making process and the decision and actions made
- Documentation of the conversations with the client related to the action or inaction
- Also, documentation of the ongoing evaluation procedure for the action taken
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/liability-hot-potato-defensive-therapy-practices-that-give-clients-inadequate-care
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 including grievance and refund policies.
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!
References mentioned in this continuing education podcast:
Ahmed, N., Barlow, S., Reynolds, L., Drey, N., Begum, F., Tuudah, E., & Simpson, A. (2021). Mental health professionals’ perceived barriers and enablers to shared decision-making in risk assessment and risk management: a qualitative systematic review. BMC psychiatry, 21(1), 1-28.
Carroll, Andrew, and Bernadette McSherry. “Risk management in the era of recovery and rights.” BJPsych Advances 27.6 (2021): 394-404.
Goldman-Mellor S, Olfson M, Lidon-Moyano C, Schoenbaum M. Association of suicide and other mortality with emergency department presentation. JAMA Netw Open. 2019; 2(12):e1917571.
Mullen R, Admiraal A, Trevena J. Defensive practice in mental health. N Z Med J. 2008 Nov 28;121(1286):85-91. PMID: 19098951.
Rinaldi, C., d’Alleva, A., Leigheb, F., Vanhaecht, K., Knesse, S., Di Stanislao, F., & Panella, M. (2019). Defensive practices among non-medical health professionals: an overview of the scientific literature. Journal of Healthcare Quality Research, 34(2), 97-108.
*The full reference list can be found in the course on our learning platform.
Relevant Episodes of MTSG Podcast:
It’s the Lack of Thought That Counts: Ethical decision-making in dual relationships
Risk Factors for Suicide: What therapists should know when treating teens and adults
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):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:15
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 0:47
Once again, hop over to moderntherapistcommunity.com for one CE once you’ve listened well.
Curt Widhalm 0:54
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 about the things that we do in our practices, the ways that we interact with the world, the continuing education that we earn by listening to Katie and Curt. And today we’re talking about defensive therapy practices. And this is all of the things that we hide behind our or that we use to hide our anxieties, or we just flatly put our anxieties out there. And we do these things that might not always be in the best interests of the clients. And so this is, as I mentioned, in one of those continuing education episodes, you can check out our show notes, or listened to the intro-duction, or the outro-duction of the episode for your instructions on how you can earn CEs through us. But when we talk about defensive therapy practices, Katie, what comes to mind just as far as that being a term upfront.
Katie Vernoy 2:06
It makes me very curious about what offensive therapy practices are.
Curt Widhalm 2:10
Oh, offensive therapy practices, I think is very much just like, all of the things that you’re like reading on social media, like I can’t believe a therapist actually said that. So…
Katie Vernoy 2:23
It is pretty offensive. But as far as, but as far as defensive therapy practices, to me, it seems like it’s folks that are so worried about whatever risk that’s there that they, they get super protective of themselves, and they won’t do anything, or they do crazy things. And it’s like, get really rigid, we have a whole conversation about the development of therapists and rigidity. But like it just seems like the risk level becomes so intense that therapists are only worried about themselves and the risks that they hold, versus what’s in the best interest of the client.
Curt Widhalm 3:03
Yes, so defensive therapy practices, as you’re describing, are pretty much exactly that. It’s actions taken by a therapist that have minimal to no beneficial aspects for a client done with the intention of reducing the legal liability on the therapist.
Katie Vernoy 3:25
So the legal liabilities.
Curt Widhalm 3:27
Yes.
Katie Vernoy 3:28
Not other types of liability that we’re reducing here, or does that is that too much of a nuance there?
Curt Widhalm 3:34
What are you asking about as far as other types of liability because I’m in 90%, law and ethics brain right now. And I can only think of liability, meaning to law and ethics.
Katie Vernoy 3:44
I think like business liability, like, like, if I take on this client at a reduced rate, and they, they need a lot of care, I am making my business less like less viable. Because I’m making less money.
Curt Widhalm 3:59
So financial risk to the therapist.
Katie Vernoy 4:03
Financial liability.
Curt Widhalm 4:03
Yeah. So I think you’re probably going to end up with some questions throughout this episode on like, is this a defensive liability thing, and I will reserve that as far as the point of this episode goes, we’re gonna put the financial questions, that’s not part of what we’re talking about when it comes to legal defensive liability here. And I think that that’s a really important distinction, because there are decisions that therapists make that affect clients, but it’s more for the finance things. Think of this more of an episode is like if capitalism didn’t exist, and here’s the steps that we’re doing just to minimize our steps as legally liable for clients.
Katie Vernoy 4:45
Wow, I’m imagining capitalism not existing. Let me just sit with that for a minute. That’s so nice. Okay, continue.
Curt Widhalm 4:54
So there tends to be two kinds of defensive practices that therapists can typically fall into. One of them is avoidant practices, things that we don’t stick our necks out for in order to avoid, you know, being liable for things. And you know, just as a quick thing, we’ll get into a few more examples here in a few minutes. But as a quick example of this, it’s like, I can’t make any opinions about anything to my clients because if they go, and they have a bad experience with that, they’re going to trace that back to me, and they’re going to blame me for that. Like, I can’t say, I like the restaurant across the street from my office, you should try it out. Because the client might go there and get food poisoning, and then they’re gonna sue me because I told them to go there.
Katie Vernoy 5:45
Or it could be pressuring a client to try a restaurant of your friends. And now you’ve got to dual relationship and you’re using your power over your client to make them do things.
Curt Widhalm 5:56
Okay, so that’s, that’s not an avoidant practice, avoidant is I’m not doing these things, because I’m imagining this super giant risk.
Katie Vernoy 6:03
That’s what I’m saying. Avoiding things because Oh, my God, it could be a dual relationship. Oh, my gosh, it’s, it’s something where if I, if I give any advice, I am legally liable because they are going if they take it, it’s because I’ve done something wrong.
Curt Widhalm 6:18
Right.
Katie Vernoy 6:19
Okay.
Curt Widhalm 6:20
The other types of defensive practices are what’s called assurant practices, or things that we do that are maybe too big and too fast of steps, in order to just absolve ourselves of any liability that could end up happening. And this is things like…
Katie Vernoy 6:41
…hospitalization, right?
Curt Widhalm 6:42
Hospitalization is the very big example of that. So we’re going to kind of take some of the first part of the episode here and break down what some of these practices are, and how they end up being things that fall within these defensive practices. And we’re gonna talk through some examples throughout the episode here. And at the end, we have some recommendations to be like, Don’t be anxious, modern therapists. But a lot of this does start with just kind of fear of being sued. And a lot of you know, from the very beginning of therapist andragogy. Love this word.
Katie Vernoy 7:25
What is therapist andragogy?
Curt Widhalm 7:27
Andragogy is the ways that we teach adults, pedagogy means peds, kids, children. Andragogy is adults.
Katie Vernoy 7:39
Teaching adults.
Curt Widhalm 7:41
But think of every grad schools first semester classes includes phenomenal law and ethics classes. And…
Katie Vernoy 7:49
That are so scary, so scary.
Curt Widhalm 7:53
So let’s, let’s start with that. Why is it so scary? What how are most of these classes taught?
Katie Vernoy 8:00
Basically, whatever you do, your client is going to either sue you or die. Or you’re going to get in trouble and lose your license, or you will never be able to get your license because you somehow did something wrong. And it’s almost like it’s worse than taxes. Because like with taxes, the all the memes, I was seeing, like, it’s like, you’re gonna do something wrong, and you’re gonna get penalized for it. We’re not going to tell you how much you have to pay, you’re just gonna get something wrong. And that’s kind of how law and ethics is felt is like, if you do anything wrong, and and you don’t know what it is, like, there’s ways to describe it. But it’s kind of written in this weird code. And there’s also all of the myths that everyone’s telling you like, everything is a dual relationship, all dual relationships are bad, like all the stuff that it’s like, if you don’t follow all of these rules, and the rules that keep expanding out and the rules that you don’t know, you are going to hell. It just gets so scary.
Curt Widhalm 8:56
And in addition to that, you’re going to have laws named after you. And you’re going to be taught in every other law and ethics class based on how dumb of a decision you made. It is taught in this very fearful sort of way that you have to do all of these things in order to not be in trouble. And you’re going to be made this example of that sets this, you have to be perfect at all points in your career. And it leaves us from the very beginning of our career feeling in this situation of the best way to not make mistakes is don’t take many actions and…
Katie Vernoy 9:33
Take actions that are going to protect you, like get really defensive, protect yourself at all costs.
Curt Widhalm 9:40
And so this leads a lot into just kind of this lawyer phobia sort of thing. Like if I can just avoid all of the lawyers, I can avoid all of the subpoenas, I can just stay within this really safe bubble of things that I can treat really well. Then I don’t have to put myself at risk for anything. And this ends up being things that over time, have, you know, through the therapist game of telephone that ends up just being like this contagious fear that we all get left with. I mean, I admit that in preparation for this episode, I’m actually going to be changing some of the style in which I teach, because…
Katie Vernoy 10:23
Oh, interesting.
Curt Widhalm 10:24
…I’ve made jokes at some of the law and ethics presentations that I’m at, you know, from the beginning, hey, this is six hours of law and ethics. If you don’t walk out of here, at least a little bit anxious, then I’m not doing my job. I really taking a lot different perspective on this, from my end of things, because I think that there’s some different answers in this. But it really takes a look at our field of not being avoidant of taking steps, it’s being able to look at the steps that we’re taking a more deliberate way, in order to avoid liability, not just passing the liability on to somebody else. Now, the first example that we’re talking about here, is talking about avoidant practices that we ended up taking. And, you know, just kind of brainstorming before recording the episode here, we had come up with a few, but some of them you’ve even talked about here a little bit. But the first one that had come up on our list is therapists and talking about medical things.
Katie Vernoy 11:37
Yes, medical advice.
Curt Widhalm 11:39
So we’re not doctors.
Katie Vernoy 11:41
No.
Curt Widhalm 11:41
We…
Katie Vernoy 11:42
We don’t play doctors on TV.
Curt Widhalm 11:44
We don’t unless you are one of those actors, turns therapists who had a previous career of playing a doctor on TV. There’s a reason that we go into psychopharmacology classes. There’s a reason that that is mandated in most jurisdictions, to understand the mechanisms of why certain medications work with certain things. Should you tell clients that they should go and get a certain kind of medication? Absolutely not.
Katie Vernoy 12:11
No.
Curt Widhalm 12:13
Should you recognize, hey, this is something weird, that’s often associated with this medication that you’re on, you should go and talk to your doctor about it. That is talking about medical stuff. And that is very much within the wheelhouse of the competence that you are expected to have as being a profession in this field. But like you said, there’s just kind of this avoidance of like that is outside of the scope of what I do. But there’s been a number of times across my career where I’ve identified with clients, like, Hey, I know you’re talking about hallucinations, you’re talking about voices that you’re hearing, I went back and I looked up some of the side effects on some of your medications. And this seems to be tied to your asthma inhaler. We should talk with your doctors about if this is something that can fix this onset of these kinds of things that weren’t here six months ago.
Katie Vernoy 13:09
Sure. And I think there’s there’s that which is kind of like, Are there mental health impacts of whatever’s going on? Or there’s side effects from psychotropic medication, that kind of stuff. But I even go as far as being able to help my clients prepare for doctor’s appointment. How do you identify what questions to ask how do you make sure that you’re bringing up any potential side effects or things that you’re you’re seeing, helping them to identify what are the things that you need to make sure you tell your doctor, obviously, then trusting the doctor will also ask questions that will expand that out and not saying this is the sum total of everything you should talk to your doctor about. But I’ve had folks that have a lot of anxiety around it, or a lot of chronic issues that are, you know, that we have to tease out what’s mental health and what’s medical. And so for me, I go pretty deep into it. But I always caveat with I’m not a doctor, and I don’t give medical advice. But I think there’s people that are so afraid of it, that they don’t even walk into that arena at all. And it’s hard to separate out. I mean, like, the more that we can be whole people, I think the better that we that we end up helping our clients.
Curt Widhalm 14:19
Well, what you’re describing…
Katie Vernoy 14:20
Or that we look at them as whole people, sorry,
Curt Widhalm 14:22
Well, what you’re describing, though, is you’re not giving medical advice. You’re giving advice on how to talk to their medical professionals.
Katie Vernoy 14:27
Yeah, absolutely. But I mean, like, deep into it and the thing is that I have so many medical conditions that I know a lot from lived experience. And so I know that I’m tapping into Well, you might want to ask your doctor about this. Because I know it right. And I I read Medscape and I enjoy medical stuff and learning about it. And so it’s something like Oh, I read this thing the other day, maybe you should bring that up to your doctor.
Curt Widhalm 14:54
The call to action piece on something like this that you’re describing the limits of your competence, you’re working within the scope of your license takes this from, I need to avoid this at all costs to, here’s the limit of my knowledge, here’s the people who can actually help and extend what you’re talking about here, in order to be able to help the client. And I think that that’s the blind dude, we’re bravely stepped into, when it comes to I’m working within the scope of my license. And I have this knowledge, and here’s how to talk with the professionals in that space for you to be able to do this. But you’ve also, in some of the conversations we’ve had talked about some of the defensive practices that medical practitioners have had with you.
Katie Vernoy 15:44
Oh, yeah, yeah, no, I went to a specialist. And this was like a general specialist. It was like an OB GYN or something. So somebody that would theoretically be an only doctor that a female, or a fab person would have gone to. And I was like, Hey, I’ve got this completely unrelated thing. Can you look at it and tell me if I need to go to the doctor? And the doctor is like, nope, not I’m not taking a single look, I’m not going to do anything. I’m like, can you just tell me if there’s something I need to do here? Or can I just like, write it out? They’re like, Nope, you have to go to the right doctor. And so yes, this was a specialist, it felt like a pretty broad specialist, because you know, like, assuming that most folks who are going to be seeing a client or a patient every year are going to have a lot of extra knowledge, like therapists do, right? Like we’re supposed to know everything, we’re supposed to do everything. But yeah, didn’t, would not look.
… 16:45
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Curt Widhalm 16:45
Now you strike me as somebody who’s potentially smart and knows how to talk with professionals.
Katie Vernoy 16:53
Potentially smart?
Curt Widhalm 16:58
You have seemingly the confidence to be able to speak up to your caregivers and providers and that kind of stuff.
Katie Vernoy 17:05
Yes.
Curt Widhalm 17:05
And I would say maybe more so than your average run of the mill consumer, when it comes to…
Katie Vernoy 17:12
Yes. I’ve had to get a lot of doctors since I was like, 16. So yeah, I know how to talk to doctors.
Curt Widhalm 17:18
So, I realize we’re talking about medical practitioners in this example here, but there are a, there is a large part of the population that would say, Hey, Doc, I have a concern about this. And the doctor saying, I can’t comment on that. And the consumer in that situation would just be like, Oh, it must not be a cause of concern. And this is one of the things where defensive practices in medicine, what we’re talking about here, but also, within mental health end up being something that can provide sub optimal care to clients. And this is where ethics codes do encourage us to talk about the limitations of our knowledge in some of these situations, in order to be able to help clients make informed decisions. You can say, hey, I don’t know a lot about this particular thing that you’re bringing up, here’s the limits of my knowledge on it, you should talk to somebody who’s more specialized in this for help on this. And as an example of this, and I have a client that I’ve worked on and off with for years, and has given me permission to educate anybody and everybody about our process, because it’s so far been successful. But I had a teenage client that I worked with for a few years surrounding some just general teenage stuff, that was a referral to me. And they went off to college for a couple of years. And they came back for some other issues. And during that process, they identified to me, Hey, I think I might be trans. And I said, Hey, great, I’m supportive of you. I have 4% knowledge on how to be a great therapist for a trans person at this point in time. And we talked through a lot of what that meant, as far as our working relationship at the time and client made their decision to continue treatment with me based on a lot of the limitations that we discussed. The takeaway in this is, we talked about the limitations of our knowledge or competence in this area, we set out a plan for this. And most importantly, the client was able to opt in to the parts of the treatment that they wanted. And this is really that that basis of our our good ethics codes of helping patients have autonomy in making their choices. There’s plenty of great therapists working with the trans community around me in the Los Angeles area here but client felt that the relationship was something that was more beneficial to them at the time. And over the years, there’s been some things that the client has been at the forefront of knowledge and teaching me for my benefit that I’ve been able to pass on to some of my other trans clients. And some of the things that I’ve done as far as my education and becoming a better therapists have then led to some other great things for this client. So the takeaway here is: I do see therapists sometimes presented in those situations with, you’re presenting something clinically to me that I don’t have any experience with, and therefore I can no longer provide any treatment to you.
Katie Vernoy 17:42
Yeah.
Curt Widhalm 17:55
And this ends up becoming one of those big avoidant practices that we really just provide sub optimal care by just shoving people away rather than really exploring a lot of what their options are.
Katie Vernoy 20:54
Well, I think there’s another piece that came to mind when you were talking about that. And it’s more of an assurance defensive practice, which is, I’m going to require you to get a medical clearance, or I’m going to require you to get X, Y, and Z, and potentially actively referring out or doing some of these things, in order to protect my liability, even though what you’re describing. I don’t know that it’s of concern. And an example, to think of an example here, someone who comes in and is talking about, I’m having a lot of panic attacks, but I don’t know if they are panic attacks. And there’s this going on medically, and I’ve got high cholesterol, and I have this and that, and the therapist saying you need to get medically cleared before I will see you again. You know, like it’s that thing of like, wait a second, I’ll say hey, go to the doctor, this is important that you see the doctor, but I’m not going to stop treating them. And I’m not going to force them to do something that is outside of the scope of my practice anyway. I don’t know, maybe this is a muddied one, a muddy example. But like I’ve seen people putting some sort of hurdle in front of a client, for them to get treatment, because their people are so worried about something that’s outside of the scope of their practice.
Curt Widhalm 22:17
A lot of this is just boiling down to I want to make sure that somebody else is assuming the liability. And as long as I’m not the target of that liability, then I can be safe by taking no action.
Katie Vernoy 22:34
Yeah, yeah.
Curt Widhalm 22:36
And there’s a fine line here. I mean, this is kind of, you know, I don’t want to spend a ton of time in this episode talking about this. But this ultimately comes down to kind of some different ethical lines of thought. There’s the the deontological, like, if everybody does this kind of thing, and it causes harm, then nobody should do this kind of thing versus the utilitarian well, we’re gonna base this based on what the outcomes are. And if I take action, and it’s good, then therefore the action was good. And it I don’t think it’s as black and white as those two differing viewpoints. That there really is more of, okay, what is the thought process of what the potential benefits and harms are in taking a course of action?
Katie Vernoy 23:22
Yeah.
Curt Widhalm 23:22
I saw this during the pandemic, when everybody was working virtually. And some of the families reaching out to me saying, hey, my kid is very at risk of harm, suicidality, psychosis sorts of things. And nobody is willing to work with us, because they’re afraid that things aren’t going to be under control. And so this becomes rather than a joint discussion with families, as far as, here’s the capabilities we have, and here’s what a treatment team looks like, in this particular situation. It might not be 100% as far as what we’ve known pre pandemic. But here’s opting into this, as far as an informed decision for everybody involved. That it’s kind of jumping to that flat out, I’m not going to provide any treatment that could potentially keep your kid out of the hospital, versus we can maybe slow down to the downward spiral that people are on. It might not be with great outcomes, but it’s at least something that still benefiting the patient. And that decision being entirely based on am I going to get sued if this doesn’t go correctly, being the part of this making it a bad defensive practice.
Katie Vernoy 24:41
It’s interesting because I as I hear this, I think about a case and I’ll change some details to make it appropriate. But like that, I I ended up referring out after seeing the client for maybe a month or six weeks because it was something where I didn’t have the bandwidth in my practice. This was a client, who when he called, it was clear, there was a few things that there was a little bit of risk there maybe some suicidality, it was more kind of vague suicidality, but didn’t really get the full picture until he came into my office. And then as we were talking, it became clear that he was having hallucinations, which I’ve worked with, with different kinds of psychosis, I’ve had other types of things. But this was something where I hadn’t done it in private practice. And my practice was full, I had many other things that I was doing. And as I was assessing this client, I realized he probably needed both twice a week sessions, as well as coaching calls. There was a psychiatrist already on board. But, you know, he hadn’t warned me, the psychiatrists hadn’t warned me that that this was the case, that there was this these hallucinations that were pretty impactful on this client. And I realized pretty early on, I can hold this client for the amount of time it takes me to find somebody to referred this client to. Because I couldn’t, I think there was an element of liability there. But it was also I don’t think that I can do the best work and be the right therapist for this client, given what else is on my plate. I think, if I had nothing else, I probably would have been great for him. But because of everything else, I felt like the I don’t know, I don’t know if it was liability. I don’t know what what, you know, I don’t know how to describe that decision making. But for me, not seeing me was what I considered more important than I don’t know exactly where the liability defensive practice stuff like that came in there. But I and maybe we can tease that out. But I think for me, I did not see a realistic way forward with this client, given my capacity.
Curt Widhalm 26:54
Right. I know that you don’t like this. But…
Katie Vernoy 27:00
I don’t like this? What you don’t I like?
Curt Widhalm 27:02
You don’t like what I’m about to say. But coming from being on ethics committees, looking at therapist decision making processes. What clarifies this and what shifts this from avoidant bad decision making to a mistake was made, but I had the right decision making process is going through kind of those ethical decision making things. And it’s really being able to lay out, okay, you know, what part of this is shaped by things going on in my life, you know, the personal things that are happening that, you know, might be some of our emotional capacity being over booked, and not having enough of a time to meet with a client multiple times a week, not having enough of a treatment team decision, and how that is communicated to the client as part of this process. That’s actually good steps that aren’t defensive practices, that’s just good decision making. And that’s the stuff that actually reduces our liability. When you’re talking about like, Okay, some of this stuff is muddied some of this stuff could have been tied to this, some of this stuff could have been tied to this. When we look at that kind of stuff, from an ethics committee standpoint, the more clear that you lay out what your thought process is, in making these decisions, it’s a little bit that slower thinking kind of thing. That’s what shifts it from being an defensive avoidant practice to, here’s a prescriptive assurant practice of, yep, clearly, this is being done for the benefit of the client, not in kind of this murky, like, oh, at the end of the day, this is just to avoid having any liability with this client.
Katie Vernoy 28:49
When I was looking at it, the first thing was, this is an insurance client. And so, you know, I didn’t have the capacity in my business to have that much time taken up by an insurance client. And maybe that’s wrong, but it was just my financial reality at the time. There wasn’t the other element of I didn’t have the time for all those things. But I also didn’t have the emotional capacity for all of those things. There was a lot going on in my life. I, you know, I’m picturing, you know, some of the coaching calls I did during the time that I saw this client where when I was out and about like it was I was doing other things and so I had to pull over to the side or you know, get enough privacy and have these coaching calls. And so it was disrupting my daily life, which I didn’t have the resources or the resilience to to manage. It was something where I think this client was constantly on the edge of whether or not they should be hospitalized. And, you know, we did safety plans. I think we did the right things. And the client did not go to the hospital the whole time that I had him of course, you know, of course the next therapist hospitalized him almost immediately so there’s a whole other conversation about their defensive practices and whether or not I was better or worse for this client, but but it was something where knowing how much of a of a mental toll that was going to take and how fearful I always felt for this client, like, Am I doing enough to keep this client from either having to go to the hospital or from dying by suicide. And so there, I think it was that there was the emotional element to it. And I knew that I, even though I knew what to do, you know, safety planning, coaching calls, being available, you know, kind of creating a team within their family and trying to add to the, to the service providers. I didn’t think I could consistently stay up to that standard. So in my mind, I felt like I was doing what was in the best interest for this client. But some of it could have been more mental gymnastics, because I didn’t want to have a client with this much risk involved in my case caseload in private practice. Like I didn’t sign up for that, like, I’m good at it, I can keep people out of the hospital for years, I understand it’s a skill that I have. I did not, especially at that time, I did not have the capacity for it. And the client was very upset. They even even though it was only several weeks that we were in this process, you know, I think, I think in the second week, I told them, I was going to have to refer them out. But but I just didn’t couldn’t find the right person, I couldn’t find a referral. And so they were very connected to me, they wanted to stay with me, they were upset, I got a call after they’d been hospitalized, like I want to come back. Like there was all of this, that was basically like, you’re doing the wrong thing, Katie, you’re being selfish. And so for me, it was it was a hard decision.
Curt Widhalm 31:37
And in those hard decisions is where we want to be able to go through these thought processes. And being able to do that helps us to be able to more clearly define for clients: this is for the benefit of your treatment. You know, if we’re talking about this as a defensive practice, what takes it out of defensive practices, we’re doing something for the better treatment for you as the client, as opposed to, I just don’t want to be responsible if things go to crap. And…
Katie Vernoy 32:10
Yeah, it’s just, it’s, it’s not cut and dry.
Curt Widhalm 32:15
And parts of this, and this is one of the takeaways that I was hoping to save more for the end of the episode, you know, wrap up podcast episodes with like, good calls to action sorts of things. So, you know, some of this is, we, as a field do have some pretty good prescriptive steps to take in some of these decisions. For example, Tarasov decisions. There are specific steps that are encoded into case law or statutes in most jurisdictions. When a client makes a threat against a foreseeable, you know, target or targets, you do these steps and you are removed from liability. That is great. That is there is no, you know, defensive practices that could be done better than that full stop.
Katie Vernoy 33:07
Yeah, although I think some people use those types of things to do assurant practices, which we’ll get into in a minute. But like, I agree, I like having those prescriptive steps. And, I mean, do you feel like there are prescriptive steps besides and we’ll we’ll add the episode in the show notes on that has the, the ethical decision making 17 bazillion steps that, that you can go through it’s surrounding dual relationships, but I think it’s, the process is useful in all areas.
Curt Widhalm 33:40
Sure.
Katie Vernoy 33:40
But is there beyond that 17 step process? Is there something prescriptive for referring out, for example.
… 33:48
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Curt Widhalm 33:48
I’m gonna bring another episode that we talked about, and this was actually a couple of episodes, but working around suicidality. There’s really concrete, black and white spaces, like client makes threat to go and kill somebody else. There is a very discreet amount of time that you have to be able to follow those kinds of things. There’s very discrete time periods that you have to take actionable steps. Chronic suicidality versus acute suicidality is something where there’s a little bit more flexibility, it’s less defined sorts of things. And so we don’t have tons of things within our field that have these very discrete moments sorts of things where you absolutely must do this, at least here in California. You know, you have certain periods of time that you have to report child abuse, or you have to report elder abuse, that those things give you very prescriptive steps to remove your liability. You know, I see this I hear stories I hear horror stories of therapists who have been working with clients for months or years even and the client, you know, calls up, hey, I’m feeling suicidal, I need another session this week, right? Something bad has happened. And I’ve heard therapists who are like, I don’t work with suicidal clients, here’s a referral. End of relationship.
Katie Vernoy 35:16
Yeah, no, I don’t know that I’ve ever done that that’s, that feels really abandoning.
Curt Widhalm 35:23
Because it is.
Katie Vernoy 35:27
But I think it’s just, it’s hard, even from somebody that it’s right at the beginning, you know, like, I feel like it’s it, I get that there are prescriptive steps, but sometimes it just feels like, there are so many gray areas and wiggle room and all that stuff, even reporting child abuse, I feel like people have a lot of gray areas and…
Curt Widhalm 35:46
Child abuse things… I want to finish up the suicide thing first.
Katie Vernoy 35:48
Okay.
Curt Widhalm 35:50
Right. Sometimes what the prescriptive steps are, is being a good therapist. It’s, you know, working with suicidality, it’s ongoing assessments that unfortunately, takes work therapists, like you have to like, keep coming back and being evaluative of where your clients are. It’s not just like, Oh, you’ve been given the suicide assessment. That means that you’re good because you pass it. No, that’s a snapshot in time. You have to continue doing the work. And so the, we want to have, you know, this really easy. All right, I did A, I did B, I did C. Here’s the level where I absolutely need to hospitalize people. But when we do these assurant steps of hospitalizing people way too early, one of the things that we talked a lot about in that episode is this 2019 article from JAMA about, here’s all the after effects of what happens when you hospitalized people at way too high of a level that they end up making more future suicide attempts, they end up having more accidents. And it’s something that ends up being the absolute best example of here’s a defensive practice that is worse for clients in a lot of situations. But it’s done because it removes that liability from the therapist, at least if you’re locked up somewhere for 72 hours, you can’t theoretically sue me for making things worse. But what I’ve found in working a lot more with suicidality, working a lot more as part of a treatment team here in my practice, where we have people available for coaching calls, it might not be your individual therapist, but we’ve got people who can take those coaching calls in those moments and help work people through kind of a crisis moment. It ends up being something where we get people not going to the hospital, and we get people dealing with things in their life and actually teaching skills and providing support at the level they need. My practice is set up a lot different than yours.
Katie Vernoy 37:59
Yeah. You’ve got other people.
Curt Widhalm 38:01
I’ve got other people, and it’s something that we like doing because it works. And we hear from clients: Oh, my previous therapist would just send me to the emergency room. And I knew what to say when I got there to where they wouldn’t admit me.
Katie Vernoy 38:16
Yeah.
Curt Widhalm 38:16
And I didn’t need to go there. I needed somebody to do this instead.
Katie Vernoy 38:21
Sure. And I think the thing that, that you’re asking us all to do, and not you, but like, what this what we’re saying here is that we have to sit in the gray a bit.
Curt Widhalm 38:34
Yes.
Katie Vernoy 38:35
Because there’s, you talk about these prescriptive things and they sound good, but I feel like there’s a lot of interpretation. I think there’s a lot of knowledge that is required from therapists and uncertainty that we have to sit sit with as we’re going through these processes, even if it’s the wonderful 17 stage, you know, you know, ethical decision making process, I think that there’s this element of this can be very hard, it can feel like I’m making a very subjective decision versus having a prescribed process that feels like I’m doing exactly the right thing, because I think it doesn’t always feel that way.
Curt Widhalm 39:19
Gasp, horror, I must do things that are expected of a mental health professional rather than just following a manual that somebody else wrote for me to follow.
Katie Vernoy 39:31
And I get it. This is part of the developmental stages and the rigidity that we talked about the development but developmental stages episode. I think it’s it’s something where when we’re dealing with risk, especially with clients that have very high levels of suicidality, homicidality, where there’s a lot of stuff that feels really scary or you know, eating disorders, substance abuse treatment, like people have these things that are like oh my gosh, these things are so scary and they were few or domestic violence or intimate partner violence, there are so many places where people get so afraid of these things that having some sense of security is, is more likely to have more folks actually being able to or wanting to engage with these types of clients. Because it is scary.
Curt Widhalm 40:21
And this is part of the change that I’m asking for here. It’s changing the way that we approach things. Eating disorders are a great example of this, that it does require a very good education on how to work with eating disorders. Unfortunately, the way that a lot of eating disorders therapists talk about it is you are damaging any and all eating disorder clients, if you engage with them, because look at the death rates, you know, it’s all of this anxiety sort of thing that pushes more of this, avoid working with eating disorders, to developing clinicians or people who just don’t have the experience working with them. Rather than being here’s what good eating disorder treatment looks like, here’s the level of support where you must insist on referring out.
Katie Vernoy 41:16
Yeah.
Curt Widhalm 41:17
And that’s really more of the takeaway of this is we need to change the way that we talk about working with clients, it’s providing supports at the levels that are needed, rather than managing clients down into don’t don’t you say anything about this, because otherwise, I’m going to have to report you to some outside body, you know. Careful on how you talk about child abuse. Because you know, if you tell me too much about this, I’m gonna have to tell, you know, social services about mommy and daddy.
Katie Vernoy 41:47
Well, I mean, and we need to, I guess, talk about assurant practices, defensive therapy practices, too. But I think child abuse is definitely one where it feels prescriptive, and people report too early. I think there’s certainly hospitalization, which we talked about, but even calling the cops or any of the things that therapists can do, which we know can be extremely harmful to clients, and potentially involve them in systems that could hurt them in the long run, whether it’s going to the hospital and increasing their likelihood of suicidality or calling the cops on someone that the cops don’t necessarily understand and could use deadly force on. And so I think there’s this element of how do we how do we address the assurant practices, because in some ways, what you’re talking about as prescriptive, suggest taking action, and I can see people bringing that down to somebody said something about their parent saying mean things to them. And so I gotta call CPS so they can assess it.
Curt Widhalm 42:57
And this, again, comes back to how we learn, how we’re taught about things, how we teach and discuss things. It really opened me to looking at abuse reporting differently, when it was described, to me by a great mentor: Start with a question, what’s the injury? A parent yelling at a kid isn’t necessarily injurious.
Katie Vernoy 43:30
Sure.
Curt Widhalm 43:31
If there’s, you know, emotional responses to that, that affect the child’s behavior, blah, blah, blah, it’s repeated, it’s, you know, contains certain content. Okay, then we’d start building the idea of, here’s what emotional abuse is. Is it abuse in all situations to strike a child? I’m looking for any kind of an answer from you…
Katie Vernoy 43:55
Well, I think this is the hard one, right? Because I think, like I had an agency that I worked at, more than one agency that I worked at where it was anything other than an open hand on the bottom is considered abuse and must be reported. And when I look at what folks can do with an open hand versus you know, somebody’s hitting somebody with a slipper, that’s like, a basically a piece of fluff. You know, I think I like the concept of where’s the injury? I think it’s something where, yeah, does, is there any reason why you should hit a child? I don’t know. I don’t I think that that it’s such a complex thing. Like what it goes back to what is hitting a child, what is actually a hit, versus something else.
Curt Widhalm 44:38
Well, and this is the part of really being able to define things and sometimes it’s worthwhile to get a little pedantic on this. What if you’re, you know, teaching a child boxing and this is part of a sparring lesson. Yeah, I would. I would imagine that striking a child in those situations is okay. So, take that take that out of context, people.
Katie Vernoy 45:02
We’ll just make a little clip of Curt saying, “Hitting a child in that situation is okay.”
Curt Widhalm 45:08
But even in these prescriptive situations, there is a still an interpretation that needs to be done.
Katie Vernoy 45:17
Yeah, I think there’s a little bit of common sense.
Curt Widhalm 45:21
It does. And that’s the part where making therapists anxious from the very beginning of their education ends up being: well I need to avoid this anxiety. And it’s what leads to more of the avoidant practices than the assurant ones. Here’s another example. In EMDR, I hear a lot from clients that I’ve worked with, I hear it a lot from other, you know, practitioners even within the EMDR world. Don’t do EMDR with pregnant people. And I look at this mostly from the idea that okay, if the eye movement too hard the the fetus in the uterus are gonna drop out? Like is that…? But it comes from this space that: Well, we don’t know, what could happen. But there’s no evidence that any bad has happened. You know, I went to a great training by Dr. Mara Tesler Stein who talked about in case anybody hasn’t noticed, giving birth is kind of a big shock to the body, for most, for both the baby and the mom, like, going through processing emotions, during pregnancy, ends up being something that, all right, if it sets the mom up for getting through stuff, so that way, they’re less likely to have postpartum issues, they’re more likely to create good strong attachments with their baby after birth, maybe we should actually be doing EMDR with pregnant people who need EMDR. It takes some precautions with these things. But I’ve had clients in the midst of EMDR treatment that come to me and they’re like my OBGYN says, I can’t continue EMDR while I’m pregnant. And I’m like, Okay, this seems to be one of those avoidant practices. And I’ve been able to convince approximately 0% of my clients or their OBGYN, that this is actually something that can be modified in good ways for some clients. But this is just such a prevalent thing within medicine and therapy, that it’s just like, alright, somebody is pregnant, somebody is too old or too young for something, therefore, it should not be done in any situation whatsoever, rather than going through a thoughtful process. Here’s why this makes sense with this person, here’s my line of thinking with this. Here’s the ethics that backup, why I can do this with one client and not another. You’re talking about things like your own capacity in being able to evaluate things. You know, it might be a super niche thing for yourself. But, you know, one of my toxic traits is trying to take on those clients that fit within my specialty, even when my caseload is too big. That…
Katie Vernoy 48:29
Yes, and we’ve talked about this Curt, you need to stop taking clients.
Curt Widhalm 48:36
But being able to take into some of the steps, you know, the the avoidant practices of like, all dual relationships must be avoided whatsoever. I need to, you know, do my banking and my religious services, seven towns over because a client might end up you know, seeing me out in public. And if that happens, then I turn into a gremlin after midnight. The verses: Okay, here’s how we hold healthy boundaries.
Katie Vernoy 49:13
Yeah.
Curt Widhalm 49:14
Here’s how we can have those discussions. Here’s the documentation, everybody’s favorite part of this process. Here’s the documentation that actually backs up that that discussion ended up happening.
Katie Vernoy 49:25
Yeah.
Curt Widhalm 49:25
So these are the kinds of things where it’s changing the discussion to be more of. Alright, in these ambiguous situations we don’t necessarily need to reinvent the wheel. But we need to question why is this rule here in the first place, and that rule may continue to benefit the particular situation you’re in. But if the the answer to it is really just I’m doing this because I don’t want to be held liable. There’s better treatment options for a client by by doing this, write it down, document it. You’re withholding beneficial things from a client to reduce your liability in these situations, you’re doing that therapy. Now, you may take a swing, and you might miss some times in doing something that could be thoughtfully beneficial to a client. It could be talking with a client about the level of supports they need, so that way, they don’t have to go to the emergency room. And they might still make a, a suicide attempt, even with those supports in place, but if you document through, here’s the thought process for why this decision was made in this moment. That’s actually what limits your liability. It’s not what the outcome of what the client did necessarily. It’s more of, what did you know, what was your thought process in doing it? And if that generally holds up to some good standards, then that’s probably the most defensible thing that you can do. It’s not not taking any action, it’s what was your thought process in leading up to the action or inaction that you made?
Katie Vernoy 49:25
So trying to get practical with this, if we go back to the example of the client that I had, who had hallucinations, was suicidal, and I felt was not I did not have the capacity within my practice. And so the documentation, if we’re talking about that, one, is my ethical decision making, am I the right person? How is a client going to be harmed? Like I said, Well, we’ll link to the full decision making process at mtsgpodcast.com. But I think there’s there’s looking at, okay, so ethically, legally, whatever the, the way that I’ve looked at this, I am not the right therapist for this client. And so I’m going to refer this client to someone who is a better fit for this client’s needs. So, so that part, right, so that’s, that’s one element. You’re also talking about documenting in session, the conversations that that I had with a client. Right?
Curt Widhalm 51:17
Right. Yeah.
Katie Vernoy 51:24
I talked with him about this as my capacity. This is what it is. And in this particular situation, he kept coming back: But no, I want to stay with you. I promise, I’ll be okay. I won’t need this many sessions for that long, I promise, please, please, let me stay. And me understanding No, this is not going to, this isn’t how this works. I would be condoning this client not telling me everything just so they could stay in treatment with me, which is not great. I continued forward with my process of referring this client out. I also wrote, I also documented a consultation with the psychiatrist around treatment planning, continuity of care, that kind of stuff. And I think I did a warm handoff, this is so long ago. So theoretically, there’s also a consultation note with the warm handoff to the new therapist. And so the fact that that client then failed out a treatment that isn’t, I’ve covered my liability, because I’ve done those things. Did I miss anything? So my decision making process, which is in my own notes, not in the clients chart, right.
Curt Widhalm 53:26
Yes.
Katie Vernoy 53:28
And then there’s the the kind of the final decision and the conversations with the client, the consultations with the other professionals, and kind of the referring the client out. Did I miss anything as far as what I document for this theoretically high risk client that I was not able to keep in my, in my, in my practice?
Curt Widhalm 53:50
The thing that I would encourage to add to that is, here’s how we evaluate this in an ongoing basis. Like it’s the way that you’re describing it is, if if I’m presenting as the client here, I promise I don’t need that much. I don’t need that much assistance. And then they do. And this is kind of where some of that clinical experience and clinical gut knowledge that we talked about is like, I’m not so sure about this. So we’re sitting in our own anxiety about this. Okay, we need to put in place that if we’re going outside of what this treatment agreement is, we need to come back and reevaluate this. And that’s the part of the discussion that I think would make what you’re describing here really, really strong. To say, this is the ongoing evaluation procedure that we’re going to use. If it’s a each time of contact, we’re going to discuss, hey, remember that this was this is going beyond what we had agreed that treatment was going to be. What other supports do we need at this time, and we need to kind of continuously evaluate, is this the right fit for what you’re presenting because I still don’t have this capacity to extend to this high. The more frequent that you come back to that conversation, when the treatment agreement is being changed, because the treatment agreement in this example is being changed.
Katie Vernoy 55:25
And to clarify, what that means is I signed this client on for once a week therapy, almost immediately that changed to twice a week therapy, which I informed my client at the time, I don’t have the bandwidth to do twice a week therapy for any length of time. And then when that was also, and then it changed again, when there was additionally coaching calls that were required between those sessions. And then it was something where being able to document this is, again, beyond my capacity right now, I don’t have the space in my practice to do this. That’s I just document those each session, each call, you know, as a reminder. I think the thing that that’s hard here is what I’m really saying to the client in this situation is you’re too much and that makes that hurts my heart. And so there’s also the piece of, of I recognize that if I had the capacity, it would have been better for me to keep this client, because they they got the message that they were too much the next person immediately hospitalized, I just like it’s this thing of like, this is why it’s hard because I could go the wrong way, and not actually take care of this client, either direction, right, not be defensive and protect my practice, but also not take good care of them. But I think there’s this element of this decision is hard.
Curt Widhalm 56:48
Well, this decision is hard. But what’s underneath that fear of telling the client that there’s too much? Now, semantics here. I don’t have the amount to support what you need right now. Yeah.
Katie Vernoy 57:06
That’s what I said. But people I have gotten clients before that, that and I’m sure you have as well that the therapists were like, You’re too much for me, I can’t handle your you.
Curt Widhalm 57:16
Right. And I see people write that as clients on the internet all the time: my therapist…
Katie Vernoy 57:22
Yeah. And it’s like, and I was trying to say, I don’t have the space, the capacity in my practice at this point for what what you’re needing, the supports that you need. I think I said it all the right ways, but it just hurts my heart.
Curt Widhalm 57:35
This is again, where I’ve had a number of things going on in my practice in my life right now that has really changed being able to talk in a very good way with clients. Here’s the level of support that I think that you need, here’s the piece of this that I can fill in and making that more of a conversation from the beginning of treatment, as opposed to being something that fits in someplace else, or ends up being several weeks or months down the line. And it minimizes the risk of that, and it makes it again, come back to more of an informed decision. But unfortunately, what I think has happened is it’s become so ingrained in therapists culture to just avoid this liability from the very beginning, that it almost becomes a standard of care to not take on anything that anybody doesn’t know the absolute most about. And that leads to kind of this therapists have to be experts about anything that they do in order to take that step. When really, it’s more, in general, we can at least be a piece of what the treatment is. And it’s again, I think a lot of the reticence to doing this is we don’t like doing the ongoing work, when it could just be simplified within experience and things that we already know. It’s ongoing work to continue to evaluate needs of a client. It’s ongoing work to go through this decision making process. It’s ongoing work to document it. It’s ongoing work to explain to clients this kind of support need. Sometimes we have the capacity for it. Sometimes we don’t. It’s not fixed as far as here’s the amount of emotional energy that therapists have. But going through this process is what actually limits your liability. If you are reported to, you know, the ethics committee that I sit on or to a licensing board and your documentation shows: Here’s the thought process. Here’s the communication. Here’s the communication, the next session about this. Here’s the evaluative process that was then discussed and talked about with the client. We would look at that and be like this therapist did everything correct. The client in this particular situation didn’t like the results of this, but the therapist didn’t do any wrong.
Katie Vernoy 1:00:01
Yeah. That all makes sense. And I like that thought process. And I think it’s something where really looking at how do you document your decision making in these processes. Where do you put this documentation? How do you make sure that you’re really going through these processes? I think it’s important. And I don’t know that that’s an episode. Maybe it’s a, maybe it’s a little handout that we create, that really talks through, like, when you’re going when you’re making these challenging decisions: This is how you cover your bases. This is how you do it. Because to me, with the way that I was taught about things, yeah, it was document, just document, document document, but not where not how it’s just make sure you document it. And I think there’s this other piece of and be very scared, and just try to stay away from all this liability as much as possible. And although it’s uncomfortable, although it takes a lot more emotional regulation to do these things, versus blanketly either push someone into something they don’t need, or refuse to provide something they do. I think there’s that element of of a lack of certainty that I think makes people really uncomfortable. And so I think we need to be able to, to do good therapy, and be smart about these things. Use common sense.
Curt Widhalm 1:01:31
And, you know, I’ve mentioned it several times in the episode, it’s, here’s the stuff to do rather than the stuff not to do here. It’s the stuff, it’s the steps that you take, it’s the thought process that you put into it. It’s documenting that, but that’s really…
Katie Vernoy 1:01:50
It’s the process, not the outcome.
Curt Widhalm 1:01:51
Exactly. You can find our show notes over at mtsgpodcast.com. You can find the references for the basis of this episode there. Listen to the intro and outro for how you can get CE credits if that’s one of the ways that you want to support us. And if you want to support us in other ways, follow us on our social media. Join our Facebook group, the Modern Therapist Group. Become a patron we have some background stuff that we do sometimes and give it only to our Patreon members or support us on Buy Me a Coffee. And until next time, I’m Curt Widhalm with Katie Vernoy.
… 1:02:28
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Katie Vernoy 1:02:29
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 1:02:44
Once again, that’s moderntherapistcommunity.com
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