If there is anything that keeps a therapist up at night, it’s the potential for a malpractice suit… misdiagnosis, diagnostic errors, and/or delayed diagnosis are at the forefront of our concerns. “What if I get it wrong?”
Braun & Cox (2005) suggest some measures that can be implemented to reduce likelihood of getting into this legal or ethical dilemma. Informed consent can help clients understand benefits, and allow the clinician to properly set expectations around the services that are covered… especially with regard to termination since additional sessions are likely to be expensive in some cases. Furthermore, clients need to be aware that counselors can no longer ensure privacy of disclosure because managed care organizations (MCOs) may require sensitive information. The release of this information may precipitate changes in treatment and outcome due to the fact that MCOs typically determine the type of treatment that should be employed and/or would be covered. We would also need to familiarize ourselves with “brief therapy models” in order to be competent at providing services through MCOs. (Braun & Cox, 2005, p. 426) If we intend to work with this specific client population we need to be well versed in all of the above considerations before we even consider taking a client that intends to utilize them as a 3rd party payer.
Although I do not consider it to be a personal deficit, historically, there is a general mistrust and underutilization of the medical and mental health communities as it relates specifically to people of color. Adequately addressing this climate of mistrust demands that we engage in an “honest and thorough self-examination of conscious and unconscious attitudes about race and the legacy of racism in the United States.” (Suite, La Bril, Primm, & Harrison-Ross, 2007, p. 883) Furthermore, Suite and associates (2007) suggest we “keep at arm’s length assumptions of cultural homogeneity and offer contextually based mental healthcare.” They define contextually based mental healthcare as “extensive and critical interpretation of the historical, cultural, spiritual, political, social and philosophical underpinnings of racism in medicine and draw connections on how these factors impact the self-identities of communities and individuals therein.” In my opinion, it is absolutely imperative that we attempt to understand how individual people of color perceive mental healthcare as an institution, as well as rebuild trust in the institution as a whole by delivering culturally sensitive options at every step of the therapeutic process.
Braun, S. A., & Cox, J. A. (2005, Fall). Managed mental health care: Intentional misdiagnosis of mental disorders. Journal of Counseling and Development : JCD, 83(4), 425-433. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=916199881&sid=10&Fmt=3&clientId=4683&RQT=309&VName=PQD
Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007, Aug). Beyond misdiagnosis, misunderstanding and mistrust: Relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99(8), 879-885. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1319356711&sid=10&Fmt=3&clientId=4683&RQT=309&VName=PQD