What I learned from the Ethics refresher

Continuing education in counseling ethics is … Hey! Don’t nod off yet. Continuing ed in ethics is like tap water; flavorless and uninspiring, yet essential to our functioning. Caught short on ethics credits with license renewal slouching my way, I chose to go back to the basics.

I knew I would know most of the material. It meant passing up  advanced seminars with alluring promises of bullet-proof protection against lawsuits. But it’s too easy to get complacent about fundamentals. At risk of looking moronic to the more-recently educated, these seven points from Bruce J. Spencer’s “Applied Ethics” course caught my eye:

1. Bartering can be okay. 

Trading therapy sessions for goods or services has long been a no-no. There’s a high risk someone will wind up dissatisfied, and that will affect therapy. Spencer suggests it can be okay – in specific circumstances. If your client lacks health insurance or better options to pay, and the client likes the proposed deal, and a peer reviews it and agrees it seems fair,  and it’s written up in a formal contract,  then bartering might be appropriate. As unlikely as it seems, Spencer suggests that in impoverished areas with limited mental health services, bartering may be the most ethical choice.

2. How long to keep records? Maybe forever. 

State laws tell us to keep records between five to seven years. That may not be long enough. Per Spencer, there have been many cases where clients filed suit over years-old psychotherapy sessions.  With the documentation destroyed, the therapists had nothing in their defense except their word. Spencer suggests we save records of those dyspeptic clients who may grow disgruntled in future. Considering a career’s worth of electronic files can fit on a flashdrive the size of one’s thumb, one wonders if there’s a reason to dispose of any client’s records, ever.

3. Burn-out is a loss of faith.

Most people view ideals and altruism as pleasant abstractions. Spencer sees them as essential to ethical practice.  To counsel clients, you have to believe (a) they can get better and that (b) you can help them do it,  (c) through therapy. When you’ve lost that confidence, you may play the role of a therapist, but you won’t perform effectively.

4.  Don’t put anyone else’s name in a chart.

You want to refer to people in your client’s life as, “The client’s second husband,” or “The client’s oldest daughter.” If the records ever get called into court and others are identified by name, those names will have to be redacted.

5. Not following up on homework could get you in hot water.

Spencer covers why we must set measurable goals to practice ethically. He also reveals therapists have been sued for not asking about progress on those goals – even for not asking clients whether they completed therapy homework.  Shocking? Not really. By relying solely on, “What do you want work on today?” the therapists floated aimlessly one session to the next. They failed to deliver services their clients agreed to and paid for. Since clients pay for our time and can’t be sure what they’ll need from one session to the next, it’s easy to regard treatment plans as busywork to satisfy insurance companies. Don’t.

6.  Void your safety contracts.

Just because no-suicide agreements won’t hold up in court doesn’t mean “contract” is a metaphor. A contract is an agreement that ends when certain terms are fulfilled, or one of the parties breaks the contract.  Let’s say a client unexpectedly commits suicide months after signing a no-self-harm agreement. Concerned attorneys could point to the not-yet-voided contract as evidence the client was still in crisis and that we were negligent by not taking action. Spencer happily agrees this scenario is uncommon. Once a clients is out of crisis, we should document the safety contract is null and void, anyway.

7.  Clients can be scared to quit.

We all remember our first clients. They couldn’t have been scarier if they’d been nine feet tall with razor-sharp teeth.  It’s easy to forget licenses and degrees bring daunting professional authority, and that clients can feel scared of us. When we review our policies and the client’s rights in the first session, we need to cover their right to get a second opinion and to terminate therapy at any time. It’s hard for a client to get better if they don’t feel comfortable saying, “I think we’re done.”

@ 2012 Jonathan Miller All Rights Reserved