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PROFESSIONAL ETHICS IN THE CHANGING LANDSCAPE OF PSYCHOLOGY PRACTICE
Gerald P. Koocher, PhD, ABPP DePaul University www.ethicsresearch.com
CE Workshop for the Massachusetts Psychological Association February 8, 2014
Workshop Goals
• Review the risk profile of your practice in context of frequent bases of complaints to licensing boards and ethics committees.
• Understand ethical problems associated with practice in the health care system, clinical supervision, and complex multiple role situations.
• Determine how to plan for adequate risk coverage when working in organizations and health care systems.
• Understand how to avoid ethical problems related to unproved or quack treatments in an era of evidence based practice.
• Formulate a plan of how to respond to an ethics or licensing board inquiry.
• Who gets in trouble and why?
• Assessing and reducing risk of ethical complaints.
Copyright G. P. Koocher (2013)
4
Risks Among American Insurance Trust Policy Holders in 2011-13
• Estimated odds of a licensing board complaint • 0.58% (.0058) up from 0.2% in 2004 • Estimated odds of a civil law suit • 0.35% (.0035) up from 0.1% in 2004
Data from the American Insurance Trust
• • *= 1 st instance of category After 2011, the carrier used sexual abuse/sexual relationship description on all claims (without exception) where there is allegation of sex or romantic relationship, even if there were other boundary violations, like gifts exchanges, etc. claimed.
• Up until 2011 the dual role/boundary violations category could have involved sex, but those after 2011 do not.
WHO GETS IN TROUBLE AND WHY?
Most Common Litigation Triggers
• Improper care/evaluation • Credit/billing impropriety • Non-sexual dual relationship/boundary violations • Suicides • Sexual abuses - dual relationship/boundary violations • Employment practices
Significant Claims and New Issues
Boundary Violations Suicide Homicide
Wrongful death Improper treatment
Dual Relationship Billing – Medicare Investigations Copyright/Trademark Infringement (e.g., website images and music) “improper punishment”-This claim alleges that the psychologist had a 6 year old boy do pushups for misbehaving.
Some things don’t change
•
Want to cut your risk of an “adverse incident” by 95%?
• Don’t engage in sexual with current or former clients or their relatives.
• Don’t do anything that someone might mistake for a “
forensic assessment
,” without adequate training, informed consent, and thorough data collection.
• Don’t switch roles in a professional relationship without well documented consent by all parties.
Psychologist accused of sexual assault on a client
• http://www.coloradoconnection.com/news/story.aspx?id=8 44852#.UO2f0HddB8F
COLORADO SPRINGS, COLO. -- A licensed psychologist has been arrested on the charge of Sexual Assault on a Client by a Psychotherapist, according to Colorado Springs Police.
Dr. Janice Husted was arrested on the charge after a police investigation. A young man told police that a sexual relationship developed between him and Husted, his psychologist.
Police said the man was assigned to receive counseling related to his combat deployments during the summer of 2010. The sexual relationship, according to what the victim told police, started in Aug. 2011 and continued until Oct. or Nov. 2011. The man said the psychologist told him on several occasions that they had to be careful to not appear that they were on dates, police said. Police said the man told the psychologist he did not want to have a secret relationship but she said they couldn't have an open relationship until two years passed. After saying he did not want to wait two years, the psychologist ended the relationship, police said.
Sexual Assault on a Client by a Psychotherapist is a Class 4 Felony.
Barter counseling for bathroom repair (NE Grand Rapids )
Reply to: [email protected]
Date: 2008-12-07, 12:09PM EST • “My husband is a capable and effecive counselor, licensed...but he is not good at home repairs/construction. I will trade his expertise for your time with him as a counselor if you can help us with tub and tile repair and plumbing. We had a termite problem that we fixed but the place needs a new floor and other stuff...if you are struggling with depression or bipolar, he is your man...maybe your spouse, child, etc. He is truly an excellent counselor. We have our own non-profit and give to others without charging so our financial situation is limited, but looking to trade! thanks.” Location: NE Grand Rapids PostingID: 948491022
Personal Risk Assessment
Consider:
• • •
Patient Risk Characteristics Situation or Contextual Risk Potential Disciplinary Consequences Modified by:
•
Therapist’s “Personal Toolbox of Skills”
Patient Risk Characteristics
•
Nature of Problem
•
History
•
Diagnosis and Level of Function
•
Expectations
•
Therapeutic readiness
•
Financial Resources Including Insurance Coverage
•
Litigiousness/court involvement
•
Social Support Network
Situational Risk Factors
•
Nature of relationship
•
Therapeutic alliance
•
Real world consequences
•
Setting
•
Rural versus urban
•
Solo practice versus institutional practice
•
Type of service requested
•
CBT
• •
Family therapy Forensic Evaluation
Therapist’s personal toolbox of skills
•
Psychological makeup/personal issues
•
Personal and professional stress levels
•
Training background/qualifications
•
Experience
•
Resources
•
Consultation
•
Access to other providers
•
Involvement with professional groups
So what should I do?
• Know the ethical and legal standards that apply.
• Pay attention to practice guidelines.
• Provide comprehensive informed consent.
• Conduct a conservative evaluation of your competence with clinical populations and activities: • Intellectual competence • Technical competence • Emotional competence Belaboring The obvious?
Communicating by Text: example 1
• “Some of my adolescent patients are inclined to sometimes touch base with me during the day via text messages. It's usually pretty intermittent, (i.e., the text conversations are not lengthy or detailed, just brief check ins). Clinically, this seems appropriately supportive to me, but I wonder about the ethical side of it vis-a-vis confidentiality. I never use my name in the text messages, but they may have my full name entered into their phone which would then show up on their screen. I will be interested to hear your thoughts about this.”
Communicating by Text: example 2
• “A variation on this occurred when I treated a young adult with a flying phobia. She had to travel by plane with several colleagues and so we worked through a graduated desensitization treatment plan. Before the actual trip she asked me to text with her while she was in the airport to get some surreptitious coping support during the most anxiety-provoking part of the intervention. I did this and it seemed to help her get through the experience successfully. But, again, I wondered about possible ethical violations. Thank you for considering this scenario as well .”
Ask yourself
• How will doing this aid the client?
• Empathic connection?
• Support between sessions?
• What hazards does this pose for the client?
• Confidentiality?
• Dependence?
• What hazards does it pose for the practitioner?
• Unrealistic client expectation?
• Clear limitations?
• Standard of care?
The “Crisis Text”
• What is the “crisis.” • Is a text message, Skype, phone call, enough?
• What is the response expectation?
• What are the patient’s circumstances
Case 1.1
• Ms. Smith, a 32 year old mother of 2, seeks treatment because of distress (including nightmares) related to a chronically disabled child. • During session 3 she expresses anxiety about upcoming testimony in a licensing hearing against a former therapist who reportedly made sexually • suggestive phone calls to her.
During session 4 she mentions for the first time that she is concurrently in psychoanalysis (of ten years duration) and that she once impulsively removed all her clothes during a session.
Citation
• Your diagnosis and next steps?
• Geist, Richard A.(2009) 'Empathy, Connectedness, and the Evolution of Boundaries in Self Psychological Treatment',
International Journal of Psychoanalytic Self Psychology, 4
: 2, 165 — 180. • DOI: 10.1080/15551020902730273 • URL: http://dx.doi.org/10.1080/15551020902730273
High Risk Patients
Patients who organize their internal object world into hated and adored objects
•
Borderline Personality Disorder
•
Narcissistic Personality Disorder
•
Dissociative Identity Disorder (MPD)
•
PTSD (complex)
•
Patients who were abused as children or are in abusive relationships
Case 1.2
• James Holmes and Lynne Fenton, M.D.
• A University of Colorado psychiatrist told campus police a month before the Aurora movie theater attack that James Holmes had homicidal thoughts and was a public danger, according to records unsealed April 4, 2013.
• Lynne Fenton, a psychiatrist at the Denver campus, told police that Holmes had also “threatened and harassed her via email/text messages” in June 2012. He is standing trial for the July 20 shooting rampage that killed 12 and injured 70 during a midnight premiere of the latest Batman movie. Soon after the shooting, university police said they had not had any contact with Holmes, a graduate student doing neuroscience research. But a search warrant affidavit released Thursday revealed that an officer had told investigators that Fenton had contacted her to report “his danger to the public due to homicidal statements he had made.”
Case 1.3 Williamson v. Liptzin
• In October 1998, a North Carolina jury handed down a $500,000 malpractice verdict against a university health service psychiatrist after a former patient went on an unprovoked and random shooting spree, killing two people and wounding several others (and who was himself wounded by responding police and subsequently tried for murder). On December 19, 2000, the verdict was overturned on appeal and the claim dismissed. Williamson v. Liptzin, 2000.
• http://www.aapl.org/newsletter/N262_Williamson_v_Liptzi n.htm
Higher Risk Patients
•
Potentially suicidal patients
• Conduct frequent risk assessment utilizing current, evidence based methods essential •
Potentially violent patients
•
Patients involved in unrelated lawsuits
•
Patients with recovered memories of abuse
Forensic Traps
• Just trying to help a friend, client, etc.
• The “vacation time referral” • Anticipating litigation • (I didn’t see that coming!) • To whom do I owe what duties • Collaterals • Clients for limited purpose
Standards of care:
the “good enough clinician” •
Mistake or “judgment call” error
•
People cannot avoid mistakes (but a mistake ≠ negligence)
•
Departure from standard of care
•
Many practitioners would not do it
•
Gross negligence
•
Extreme departure from usual professional conduct most practitioners would not do it
Understanding Professional Liability Insurance
• Occurrence Policies • Pay once, covered “forever” • Claims Made Policies • Must keep coverage current • Tail coverage (trailing claims) • Nose coverage (prior acts) 2011 2012 2013 2014 2014 2015 2015 2016 2017
DATA FROM THE MASSACHUSETTS BOARD OF REGISTRATION
2007 - 2013
121 issues raised in 112 separate cases
Charge Alcohol or substance abuse N 3 Typical Penalty Surrender or revocation of license Allowing unlicensed practice 5 Reprimand/Censure/Public Reproval/Letter of Admonition, monetary penalty Failure to comply with CE or competency requirements Improper or abusive billing 59 2 Additional education, monetary penalty Probation, supervised practice 8 Supervised practice, additional education required. Probation Inadequate records Incompetence, negligent, or unprofessional conduct Misrepresentation of credentials Practicing beyond scope of practice Practicing with an expired license Practicing without a license Sexual misconduct Substandard testing/assessment Other 3 7 1 11 13 4 1 4 Probation, supervised practice or Surrender of license Monetary penalty Probation, supervised practice Additional education, monetary penalty Cease and desist, Monetary Penalty Surrender or revocation of license Probation Reprimand, censure, public reproval, letter of admonition
121 issues raised in 112 separate cases
N Other Substandard testing/assessment Sexual misconduct Practicing without a license Practicing with an expired license Practicing beyond scope ofpPractice Misrepresentation of credentials Incompetence, neglegent, or unprofessional conduct Inadequate records Improper or abusive billing Failure to comply with CE or competency requirements Allowing unlicensed practice Alcohol or substance abuse 0 10 20 30 40 50 60 70
Frequency of MA Board of Registration Actions 2007- 2013 Surrender or revocation of license Supervised practice Reprimand, censure, public reproval, letter of admonition Probation Monetary penalty Cease and desist Additional education 0 10 20 30 40 50 60 70 80 90 100
Sample Actions by Massachusetts Board of Registration •
John S. O'Brien, Brockton
Entered into a consent agreement with the Board, agreeing to a 6-month stayed suspension followed by an 18-month probation of his license to practice psychology. O'Brien engaged in professionally inappropriate conduct while employed as a psychologist at Brockton Hospital. The consent agreement indicates that O'Brien made numerous sexually suggestive and inappropriate comments to a female patient in the course of her therapy and discussed the treatment of other patients with her. During the 6-month stayed suspension period O'Brien was required to seek a diagnostic evaluation of his ability to practice in a safe and competent manner and agreed to undergo weekly psychotherapy and supervision by a licensed psychologist approved by the Board. If the Board finds that he has failed to comply with the terms of the Consent Agreement during the period of “stayed suspension,” his license would be immediately suspended. During the 18-month probation period, the same conditions of weekly psychotherapy and supervision applied.
Sample Actions by Massachusetts Board of Registration •
Joseph F. Doherty, Cambridge
The Board placed Doherty's license on probation for one year following allegations that he failed to conduct a proper client evaluation and failed to maintain adequate and accurate treatment records. In addition, Doherty's practice was placed under review by a consulting psychologist during the one-year probation period.
•
Ellen Leigh, Arlington
The Board issued a civil administrative penalty against Leigh in the amount of $1,500 for engaging in unlicensed practice of psychology. Leigh performed the functions of a psychologist when the Board had not issued her a license. Leigh also agreed to complete a continuing education class in the area of ethics/risk management.
•
Mitchell Abblett, Newton
Under a consent agreement effective June 3, 2009, Abblett accepted imposition of a civil administrative fine of $5,000. In the agreement, Abblett acknowledged that in the course of his previous employment at the Judge Rotenberg Educational Center, he was assigned and had utilized the title "psychologist;" and that his use of that title prior to his licensure constitutes a basis for disciplinary action.
HEALTH CARE SYSTEMS, CLINICAL SUPERVISION, AND COMPLEX MULTIPLE ROLE SITUATIONS
Strangers in a Strange Land
• The content and culture of training programs in psychology differ substantially from medicine and nursing. • We use: • Different core content • Different educational sequences and pedagogy • Different socialization approaches • Different regulatory models • Different specialization models
Strangers in a Strange Land
• We sometimes don’t even speak the same language.
• a “progressive disease” is one that gets worse and “positive findings” are a bad sign when discovered during a physical examination • Some physicians seem too willing to see physical complaints as psychological, and some mental health practitioners seem all too eager to go along with them.
• The game is changing and the rules are not clear
Medical Model & Reimbursement Issues
• “Since the late 1980s, the practice of psychology has become more and more dependent upon third party payment plans to remain viable as a profession. I have opted out of this system and while this may be based on my unresolved issues with authority, my primary objection has been that a diagnosis of mental illness MUST be given or the claim will be denied. Granted, there have been changes in the description of some mental illnesses and the methods of report are a bit more efficient, I have difficulty believing that the incidences of mental illness have increased to the extent that everyone in psychotherapy is mentally ill. Does this create an ethical, if not legal, dilemma?”
Diagnosis and Procedure Codes Science versus Politics
• Uncomplicated Bereavement • Pediatric Bi-Polar Illness • Syndromes • Down’s Syndrome • Parent-Child Alienation Syndrome • DSM vs ICD • The “Mort Wiener” approach of 1973
•
The Bad news:
Psychologists’ education and training has typically not prepared us well to function within the culture of the health care system.
• Non-physicians in a physician dominated system.
• Psychiatry has at times played the role of and ambivalent partner or outright adversary.
• Ally in coverage advocacy • Opponent in Rx privileges
But the Times They are a Changing • “Most of the prescribing of psychotropic medications has been dominated by general physicians who do the bulk of prescribing, estimated at more than 75 percent of all prescriptions for psychiatric medications in the U.S…(Sharfstein, 2006) • “Psychiatric residents increasingly claim that they have no interest in psychotherapy and therefore see no point in attending seminars on the subject or meeting with a psychotherapy supervisor for one-to one instruction... “(Gabbard, 2005)
• In 2013 only 50.1% of the 1,360 psychiatric residency slots were filled by U.S. medical school graduates.
• 30 slots went unfilled and the rest were filled by International Medical Graduates (219 with U.S. and 186 with non-U.S. graduates).
• [Culture shift FMG to OMG to IMG]
The Better News
• Psychological techniques and approaches have attracted significant attention among non-psychiatric physicians.
• Integrated care service models will increasingly draw on psychological practitioners.
• Interprofessional practice has become a “buzz word.”
The Central Issues in Health Care Ethics
• What problems should we try to solve?
• What problems can we solve?
• Who drives the agenda?
Interprofessional Ethics in Health Care • Quality of Care • Communication • Integration and collaboration • respect for conflicting points of view • Solution focused • Follow through • Patient Choice • Access to information versus understanding • Non-medical variables (e.g., personal preference, quality of life, spirituality)
Sample Issues Where Psychological Care Adds value
• Autistic Spectrum Disorders • Caregiver Stress (Distress!) • Child Abuse/Neglect • Dementia • Disability Evaluation Requests • End of Life • Habit-related health problems • Pain • Payment and Diagnosis Issues • Procedure Eligibility (bariatric surgery, transplantation)
CHALLENGES OF THE EMR
Electronic Medical Records
Ethical Challenges with Electronic Medical Records
• Not simply keeping records on a computer!
• Not simply practice management software!
50
51
Definitions
• Electronic Health Records (EHR) • Focus on total health of patient across providers • Electronic Medical Records (EMR) • Digital clinical charts; not easily shared • Practice Management Software • Demographics, scheduling, billing.
• Interoperability • Ability to exchange and use information • Role segregation • An HER function that limits personnel access to need-to-know elements of record (clerk/clinician)
52
Electronic Medical Records vs. Electronic Health Records • Medical records –digital version of paper charts • Health records –go beyond one practice and integrate care across all practitioners • Meaningful use of interoperable systems sought- not simply transferring files • No mandate for psychologists yet
53
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.
• Excluded psychologists and most other non-physician providers from the list of “meaningful users” of electronic health records • Not eligible for Medicare and Medicaid incentive payments designed to encourage adoption of expensive complex systems • Lobbying in process
Cloud Computing
•
Where’s the cloud
•
How robust is the cloud
•
What’s in the cloud
• Software • Data storage •
Who has access to the cloud
•
Accessing remote computers
54
55
No mandate for psychologists (outside hospitals) yet, but when it comes how will blended access influence what you write?
• Multi-practitioner access • Patient real-time access • HIPAA and HITECH both mandate role segregation • Special mental health data segregation to be developed
Evolving Professional Roles and Conflicts of Interest in Emerging Payment Systems • What will happen as fee-for-service systems become supplanted by incentivized integrated care or “global payment” systems or will we suffer the ills of poorly run capitation systems?
• • Can we focus on the “virtuous circle of care” and value based competition? Will we manage ethically?
Porter, M.E. & Teisberg, E.O. (2006) "Redefining Health Care: Creating Value-Based Competition On Results", Harvard Business School Press, 2006.
Legal Hazards Associated with EMRs
• Risk: Because EMRs allow users to move quickly through patient records, cutting and pasting information along the way, incorrect information can easily get repeated. Prevention to the next.
: Avoid cutting and pasting data in EMRs, and use caution when moving from one patient’s record • Risk: Practitioners charting in EMRs may lead to some less thorough documentation than with than paper charts.. Prevention: Electronic notes should include full and careful documentation .
• Risk: Computerized expert systems can offer actuarial guidance in deferential diagnosis and clinical decision making, but they cannot possibly cover all contingencies. Prevention: Avoid over reliance electronic assessment and diagnostic aids. • Risk: Safeguard confidential electronic patient data can prove challenging. Prevention: Use encryption and secure access on all electronic access devices and discourage employees from taking records or unsecured content out of the office.
• Risk: Some EMR systems may not clearly document changes to records. Prevention: Optimal systems should document modifications and have a program lockout period after which no further modifications can be made to a record.
• Risk: Many states have notification requirements in the event of a data breach. Prevention: Understand and follow state law requires if a data breach occurs, making sure that all employees understand and follow requirements.
• Risk: Destruction or delete of electronic records can easily occur by accident or sometimes intentionally if a lawsuit looms.
Prevention: If sued, all records (including electronic data) related to the patient in question must be preserved, including emails, phone messages and computer records.
• http://www.ama assn.org/amednews/2012/03/05/prsa0305.htm
OTHER COMMON PROBLEMS
Dallas psychologist admits $1 million
• • • • • •
federal health fraud
A North Dallas psychologist said he treated a single postal worker seven days a week, up to eight hours a day. A federal billing contractor responded by paying the therapist more than $1 million.
Michael Ellis Wolf, 62, has pleaded guilty to a five-year health care fraud scheme and agreed to surrender his license to practice psychology. He faces up to 10 years in prison, plus fines and restitution.
There was no immediate word on how the scheme went undetected so long and whether others would face charges.
Court records identify the billing contractor as Affiliated Computer Services, or ACS, which processes workers compensation claims for the U.S. government. Xerox acquired it in 2010.
The patient was eligible for workers comp. He received therapy from Wolf once or twice a week beginning in 1996, and the fraudulent billing occurred from 2008 to 2013.
http://watchdogblog.dallasnews.com/2014/01/dallas-psychologist admits-1-million-federal-health-fraud.html/
Disagreement with Treatment Advice
• If you only have a hammer, every problem looks like a nail.
• Cardiac surgery versus Interventional Cardiology • You want me to take drugs for that?
• Using data and patient preference to drive the agenda.
Case 3.1: The ethically questionable Request Bertram Botch, M.D., serves as the chief of neurology at a pediatric hospital and often chairs interdisciplinary case conferences. Reporting on her assessment of a low-functioning mentally retarded child, Melissa Meek, Ph.D., presented her detailed findings in descriptive terms. Dr. Botch listened to her presentation and asked for the child's IQ. When Dr. Meek replied that the instruments used were developmental indices that did not yield IQ scores, Dr. Botch demanded that she compute a specific IQ score to use in his preferred report format.
Case 3.2: See one, do one, teach one.
• After sitting in on some lectures that Ralph Worthy, Psy.D., gave to a group of medical students about objective and projective personality assessment, the chief of medicine called him in to set up a workshop on the topic for medical residents. The chief told Worthy that he thought it would be a good idea to teach the residents how to use “those tests” and assumed that it could be done in “a half dozen meetings or so.”
Case 3.3: Cultural Differences •
The patient:
• 5 years old, Spanish-speaking, from Puerto Rico • Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome: an uncommon variation in the prenatal development of the female genital tract. Its features include an absent or very short vagina and an absent or malformed uterus.
•
The procedure:
• A skin graft taken from the buttocks is used to cover a stent, which is then inserted into a surgically created space between the bladder and the rectum. A dilator must be used during the months following the procedure to keep the vagina open .
•
The problems:
• The child experienced serial infections and significant pain associated with treatment.
• The mother spoke very little English and had difficulty gaining full cooperation and compliance from the child.
• The surgeon: “Why don’t you just get it done, and why can’t you learn English? You’ve spent enough time here.”
Case 3.4: Developmental Disabled Transplant candidate • The patient: • A 5 year old developmentally disabled old boy with idiopathic pulmonary artery hypertension, a progressive, fatal disease of unknown cause.
• The procedure: • Long-term therapy had not helped much and pulmonary or pulmonary cardiac transplantation seemed the last resort.
• The problem: • The child would not cooperate with pulmonary function tests, a key diagnostic indicator of rejection and could not be “listed” for transplant unless cooperative.
• How can we get this physically and intellectually challenged child to a state of transplant eligibility?
Definitional Dilemmas
• Empirically validated… • Empirically supported… • Empirically based… • Evidence based…
• Multiple types of research evidence • Clinical observation • Qualitative research • Systematic Case studies • Single case experimental designs • Ethnographic or public health research • Process-Outcome Studies • Intervention in naturalistic settings (effectiveness) • Randomized clinical trials (efficacy) • Meta-analytic studies
AVOIDING ETHICAL PROBLEMS RELATED TO UNPROVED TREATMENTS IN AN ERA OF EVIDENCE-BASED PRACTICE.
• http://www.ibrt.org/ ColorQuiz is a free five minute personality test based on decades of research by color psychologists around the world.
Panels of Experts
• Norcross, J. C., Koocher, G. P., & Garofalo, G. P. (2006) Discredited Psychological Treatments and Tests: A Delphi Poll.
Professional Psychology: Research and Practice
,
37
, 515-522. doi: 10.1037/0735-7028.37.5.515
• Norcross, J. C., Koocher, G. P., Fala, N.C., & Wexler, H.K. (2010) What Doesn’t Work? Expert Consensus on Discredited Treatments in the Addictions.
Journal of Addiction Medicine
,
4
, 174-180. doi: 10.1097/ADM.0b013e3181c5f9db.
• Koocher, G.P., Norcross, J.C., McMann, & M., Stout, A. (in press). Discredited Assessments and Treatments Used with Children and Adolescents. Journal of Child and Adolescent Psychology.
“Top 8” Discredited Tests
• • • • Bender-Gestalt for assessment of neuro psych impairment Handwriting analysis (graphology) for personality assessment Luscher Color Test for personality assessment Szondi test for personality • assessment • • • Anatomically detailed dolls & puppets to determine if child was sexually abused Blacky test for assessment of children’s personality and pathology Bender-Gestalt for assessment of personality Wechsler IQ scale scores for personality assessment
“Top 10” Discredited Treatments
• Angel therapy • Orgone therapy • Use of pyramids • Crystal healing • Past lives therapy • Txs for alien abduction • Future lives therapy • Rebirthing therapies • Color therapy • Primal scream therapy
Questionable Theories and Constructs
• • • • Bettleheim’s psychogenic theory of autism (e.g., mother as emotional refrigerator) childhood immunizations as cause of autism monocausal biomedical theory of mental disorders (Roger Greenberg) psychogenic and schizophrenogenic theory of schizophrenia • • • • • • penis envy castration anxiety Lombroso’s theory of born criminals alien abduction theory for emotional distress and trauma Jung’s notion of collective unconscious double-bind theory of schizophrenia.
http://www.neholistic.com/directory.htm
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HOW TO RESPOND TO AN ETHICS OR LICENSING BOARD INQUIRY.
Dealing With Licensing Board and Ethics Complaints
• Know who you are dealing with and understand the nature of the complaint and the potential consequences before responding • Licensing board or professional association?
• Psychologist of non-psychologist investigator?
• Formal or “informal” inquiry?
Understand the Precise Nature of the Complaint and Rules That Apply to Responses and Any Proposed Actions
• Have you been given a detailed and comprehensible rendition of the complaint made against you?
• Have you been provided with copies of the rules, procedures, or policies under which the panel operates?
• Do not contact the complainant directly or indirectly.
• If the complaint involves a current or former client, make certain that the authorities have obtained and provided you with a waiver of confidentiality signed by the client.
• Obtain consultation before responding.
Organize Your Defense and Response to the Charges Carefully and Thoughtfully
• Assess the credibility of the charge. Compile and organize your records and the relevant chronology of events. Respond respectfully and fully to the questions or charges within the allotted time frame.
• If asked to provide unusual materials during the investigatory process, do not comply without first seeking legal consultation • If offered a settlement, “consent decree,” or any resolution short of full dismissal of the case against you, obtain additional professional and legal consultation.
• If you need more time to gather materials and respond, ask for it. Be sure to retain copies of everything you send in response to the inquiry.
• Do not take the position that the best defense is a thundering offense. This will polarize the proceedings and reduce the chances for a collegial solution.
• If you believe that you have been wrongly or erroneously charged, state your case clearly and provide any appropriate documentation.
• If the complaint accurately represents the events, but does not accurately interpret them, provide your own account and interpretation with as much documentation as you can.
• If you have committed the offense charged, document the events and start appropriate remediation actions immediately (e.g., seek professional supervision to deal with any areas of professional weakness, enter psychotherapy for any • If a charge or complaint is sustained and you are asked to accept disciplinary measures without a formal hearing, you may want to consider reviewing the potential consequences of the measures with an attorney before making a decision.
• Know your rights of appeal.
Take Steps to Support Yourself Emotionally Over What Is Likely to Be a Stressful Process Extending Over Several Months • Be patient. It is likely that you will have to wait for what will seem like a long while before the matter is resolved. It is perfectly acceptable to respectfully inquire regarding the status of the matter from time to time.
• If appropriate, confide in a colleague or therapist who will be emotionally supportive through the process. Your relationship with your therapist may be protected by privilege. We strongly suggest, however, that you refrain from discussing the charges against you with many others. Doing so may increase your own tension and likely produce an adverse impact as more and more individuals become aware of your situation and may possibly raise additional problems regarding confidentiality issues. In no instance should you identify the complainant to others, aside from the board or committee making the inquiry (after they produce a signed release) and your attorney.
• Take active, constructive steps to minimize your own anxiety and stress levels. If this matter is interfering with your ability to function, you might benefit from a professional counseling relationship in a privileged context.
SOCIAL MEDIA ISSUES
Who will search you?
Who will you search?
Engaging with social media
What about searching?
• Your clients will search for information about you.
• What (if anything) does our ethics code have to say about using electronic media and search engines to check on clients?
Just a few sample options for data collection
•
CriminalSearches
•
Detectivemagic
•
•
Familywatchdog
•
Fundrace
•
•
Guidestar
•
Intelius
•
Netronline
•
NSOPR.gov
•
Peoplelookup
•
Pipl
•
Searchsystems.net
•
Spock
•
Spokeo
•
Vitalrec.com
•
Whitepages
•
Whowhere
•
Whois
•
Zabasearch
•
Zoominfo
I don’t want to get Yelped!
What can I do?
•
Monitor your web presence
•
Use an optimized professional web site and similar publicity to suppress adverse search returns
•
Hire an attorney to raise defamation claims with the website
•
Consider contractual prevention strategies
•
Consider the services or a reputation protection company (e.g., Reputationdefender.com and Medical Justice.com)
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Solicit positive reviews from colleagues
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Try to ignore them and hope they won influence consumers.
I’ve been Yelped
• Response strategies • Respond on the site without breaching confidentiality.
• • Remind readers that there are two sides to every story and that you owe all clients a duty of confidentiality Don’t mention any specifics or identifying information about the patient.
• Develop an active positive branding program • • Collect consumer satisfaction data.
Don’t make promises you can’t keep.
• Remember that the Internet is forever
Professional Web Sites:
When you control the message • Access to Information • Marketing your practice/products • Directions to your office • Downloads • Access to Documentation • Efficient communication • Effective promotion of psychologist’s skills, experience, and competencies/specialties.
But beware…
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Site security
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Boundary issues
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Appropriate marketing
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Blogging challenges
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File transfer and e-mail confidentiality
Facebook, LinkedIn, Twitter, Google Voice, What’s Next?
• Security Issues • Retention of Files • Friends of Friends boundary issues • Fan?
• Harassment • Stalking • PHI • Failure to terminate
Do you Need a Friending Policy
Sample per AIT:
“I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.”
APAIT Suggestion on “Following” Policy • “I publish a blog on my website and I post psychology news on Twitter. I have no expectation that you as a client will want to follow my blog or Twitter stream. However, if you use an easily recognizable name on Twitter and I happen to notice that you’ve followed me there, we may briefly discuss it and its potential impact on our working relationship.
• My primary concern is your privacy.”
More on Following
• “Note that I will not follow you back. I only follow other health professionals on Twitter and I do not follow current or former clients on blogs or Twitter. My reasoning is that I believe casual viewing of clients’ online content outside of the therapy hour can create confusion in regard to whether it’s being done as a part of your treatment or to satisfy my personal curiosity”
Zur Institute on Modern Day Digital Revenge
• file:///G:/Documents/MPA/Workshop/Modern%20Day%20 Digital%20Revenge%20on%20sites%20such%20as%20L inkedIn,%20Google+%20and%20Yelp.htm