Daily Archives: August 6, 2010

Confidentiality | Silence is golden!


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Confidentiality is at the foundation of safe therapy because it promotes open and candid communication between the therapist and the counselee.  This right to confidentiality has been repeatedly reaffirmed in judicial system, with the case of Jaffee v. Redmond (1996) serving as a key example.  In that ruling, Justice John Paul Stevens of the US Supreme Court wrote expressed that “effective psychotherapy depends upon an atmosphere of confidence and trust in which the patient is willing to make frank and complete disclosure of facts, emotions, memories, and fears.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 214)  Justice John Paul Stevens couldn’t be more correct, because without a measure of confidentiality, the process of mental health treatment would not be possible.  Clients themselves would need to be constantly concerned about the ramifications of divulging sensitive information.  It is extremely important that we communicate a client’s right to confidentiality to promote that free flow of communication.  Not only are we ethically and legally responsible for disclosing it at outset, in the form of an informed consent document, but we should also endeavor to continue to have candid conversations around confidentiality as the relationships continues to develop.

We, as mental health professionals, should seek to protect the image of the larger profession and give our clients every reason to believe in our pledge of confidentiality.  That integrity aside, we also need to be candid and forthcoming regarding the limitations of that confidentiality, because it is not without exceptions.  If the client is a danger to self or others, we are bound by mandatory reporting procedures to report the incident, as well as “warn and protect” other people from potentially dangers clients.  In cases where abuse is detected, be it with children, elderly, or dependent adults, we are mandated by law to report such cases to proper authorities.  Furthermore, we should follow up on such cases to be assured that proper action has been taken.  In the case of counseling a minor, an underage client should be aware of specific limitations regarding disclosure of information to parents, particularly when he or she is a danger to themselves or others.  We also much acknowledge that confidentiality is the client’s right, and they also have the ability to waive that right.

I would hope that clients really believe what they say is confidential.  I would also hope that they understand the implicit limitations on that confidentiality before the process of counseling begins… so, they should also understand that some of what they may say is not confidential.  In any case, it very much depends on the context, the situation, the content of the disclosure, the professional judgment of the clinician, and the ethics codes, laws, and agency policies that govern our practice.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th  ed.). Belmont, CA: Brooks/Cole.

Informed Consent Document (Example)


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Chances are, if you choose to pursue the counseling profession, you will be required to produce a document of Informed Consent.  The document pretty much speaks for itself, but it really represents all the things you should probably know before you enter into therapy.  If you engage in therapy and you do NOT get an informed consent document, or, if the one you do get doesn’t address an issue that is contained here but still concerns you… you should definitely ask your therapist to qualify on that particular point.

Purpose of Informed Consent

This document has been provided as an explanation of the services I provide.  The intent is to allow you to make informed and autonomous decisions pertaining to the counseling process.

Qualifications

My name is Kent Brooks.  I currently hold a Bachelors Degree (BA) from the University of Northern Iowa in Education.  I also hold a Master of Science (MS) degree in Clinical Counseling from Bellevue University.  My title is Provisional Licensed Mental Health Professional.  Because of the provisional nature of my license, my practice is currently supervised by XXXX LMHP.  Her information is available upon request.  While I have significant experience and training, I sometime find it necessary to refer a client to another more qualified professional.  If a referral is in order, I will inform you and discuss possible options.  You may request to be referred to another counselor at any time.

Counseling means Collaboration

Counseling is a collaborative process between you and a counselor where mental health distresses and disorders are evaluated, assessed, and treated.  For therapy to be most effective, it is absolutely essential that you take an active role in the process.

Risks

The counseling process may open up levels of awareness and provoke realizations that may cause uncomfortable feelings, sadness, guilt, anxiety, anger, pain, frustration, loneliness, and/or helplessness.  In some cases major life decisions are made, in others traumatic events are reflected upon.  This process of growth and self actualization can cause significant impacts to employment, lifestyles, and relationships.  Psychiatric services are inexact sciences; we make no guarantees/warranties, regarding outcomes.

Appointments

Sessions are generally scheduled in 50 minute increments, once per week.  Once an appointment is made, it is assumed to be a recurring appointment.  Some situations may justify modification of the schedule, thus increasing or decreasing frequency of appointments.  Being late for an appointment by 25 minutes or more may require that you reschedule.  If you need to cancel an appointment, please contact me at 402-990-6905 at least 24 hours in advance.  Cancellations with less than 24 hours notice will be charged a $50 no-show fee.  We reserve the right to terminate the relationship in the event that 2 consecutive appointments are missed without notification of cancelation.

Fees and Payment

Co-payments with approved insurance, or payment in full, will be collected at the time the service is rendered.  The standard fee for a single 50 minute session is $95 USD.  Checks returned for insufficient funds may be subject to an additional $35 fee.  If you are subject to undue financial stress, you may request a fee adjustment based on a sliding scale so that we can continue to accommodate your needs.

Confidentiality

Your confidentiality is important to me.  The nature of the counseling profession, and the ethics and laws that govern it, presents certain limitations that need to be both acknowledged and addressed.  All communications between a mental health professional and a client are protected by law. If required or requested, I will release information regarding our communications to others with your express written consent.  (Release of Information form)  If you are under 18, your parents or legal guardian(s) may have access to your records and may authorize release to 3rd parties.

Diagnosis

Most 3rd party payers require that I provide a diagnosis to describe your condition.  Once that information is provided to insurance companies, I can accept no liability for impacts to insurability or employment.

Mandatory Reporting

Mandatory reporting requires me to report situations where the client is a danger to self or others.  Situations in which a child, elderly, or disabled person is subject to abuse or neglect are also subject to mandatory reporting.

Records

I am required by law to maintain detailed records each time we interact.  They records contain sensitive information including observational data, diagnosis, treatment plans, and other clinically relevant information.  During the course of treatment, information may be provided to insurance companies, managed care companies, and/or courts.  I will share records, in full or in part, with you as the client if requested; unless the determination is made that it may hinder progress or otherwise cause undue harm.

Consultation

I may consult with other professionals (legal and clinical) on your case.  To what degree it is possible, every reasonable attempt will be made to avoid revealing your identity to other professionals with whom I consult.  Because my license is currently provisional, it should be expected that I will regularly consult with coordinating and/or supervising personnel, listed above.

Termination

Termination of the counselor-client relationship can occur in several different contexts, but it is important that we be prepared for a termination phase from the outset of treatment.  You can choose to terminate therapy at any time.  You have a right to expect that the relationships will be terminated when you have realized maximum benefit from it, or have achieved the goals that are made at outset.

Managed Care Limitations

I am committed to providing the highest quality care available; however, limitations on my ability to provide that level of care are sometimes affected by insurance and/or managed care providers.  Limitations can affect the therapy process, length of treatment, number of sessions, and amount of money that will be reimbursed.  In some cases managed care guidelines may affect the content of the therapy.  These considerations, if they apply, will sometimes affect outcomes.  In addition, if you wish to utilize a 3rd party payer, I must be able to discuss your diagnosis and treatment with representatives of your EAP, managed care, or insurance.

Emergencies

In the event of an emergency, for which you feel immediate attention is necessary; I will make reasonable effort to make myself available.  If I am not immediately available and you reach voicemail, please leave a message indicating that the call is urgent.  Please contact 911 immediately or proceed to the nearest emergency room for immediate evaluation.

I have read, understood, agree, and consent to the above conditions of service.  I have had the opportunity ask questions regarding the above policies.

Client Signature________________________________Date_____________________________

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Matching yourself with a therapist… important or irrelevant?


The word culture can be interpreted broadly.  It can include demographic variables such as age, gender, and place of residence; status variables such as social, educational, and economic background; formal and informal affiliations; and the ethnographic variables of nationality, ethnicity, language, and religion.  (Corey, Schneider-Corey, & Callanan, 2007, p. 115)  Given this broad based definition, it is literally impossible for us to consider every interaction as anything less than multi-cultural.  No single person is capable of sharing all the traits that contribute to our cultural identity, and as a result, any attempt to match ourselves with our clients (or clients to ourselves) is an exercise in futility.  It is impossible to match client and therapist in all areas of potential diversity, which means that all encounters with clients are diverse, at least to some degree.  (Corey et al., 2007, p. 141)  It’s a safe to assume that while you may share commonalities in one specific variable, like age for example, you likely do not share one or more demographic variables that contribute to the definition of culture.

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I would suggest we tread lightly when generalize about any single group in effort to “match” ourselves to our clients… or try to match ourselves to a potential therapist.  In doing so, we not only do injustice to our clients but we do injustice to ourselves and our own personal growth.  In my own personal journey to becoming a counselor, and indeed throughout my life, I am amazed and humbled by the differences among us.  Every time we meet someone, the potential is there to see the world through a new set of eyes.  I aspire to find as many opportunities as I can to walk in another man’s shoes, and to see through her eyes, so that I can understand more fully what it really means to be human.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.