Keep in mind that everything you do as a psychotherapist is measured against the “standard of care.”
This includes choosing other professionals for consultation, supervision, or referral. If you choose unreasonably, you can be held liable.
In one case, a university psychiatrist was sued for a negligent referral. The psychiatrist saw a client named Daniel on only three occasions, in keeping with university policy. The psychiatrist noted that Daniel was suffering from “anxiety and dread,” and that he had experienced “depression” and “suicidal fantasies” since elementary school.
At their third meeting, the psychiatrist gave Daniel a list of three psychologists and one other counselor. None of these four professionals could prescribe medication, or had any experience in suicide prevention. Daniel saw one of the psychologists, whose specialty was eating disorders, for two years. Daniel terminated his treatment with the psychologist, and two weeks later committed suicide.
Under these circumstances, the court found that the psychiatrist could be held “negligent in failing to refer Daniel to someone qualified in suicide prevention or to someone who could prescribe medication for Daniel that would reduce his suicidal inclinations.”
Avoid this error. Make sure that anyone you consult with, take supervision from, or refer to is highly qualified for the client involved—not just convenient for you. In your notes, explain why you chose that person.
Process is the Key
In any particular case, you may find yourself agonizing about a judgment call. For example, does the client pose a risk of suicide? Do you have enough information to reasonably suspect child abuse? Should you let the client see his or her records? Would a family therapy session benefit the client?
This is a critical point: the law does not require you to make the right judgment call. Instead, it requires you to make the call using a reasonable process.
Documentation will enable you to prove that your process was sound. For each agonizing judgment call that you face, your notes should reflect the steps you took to resolve it. These steps could include, in any given case:
- Consultation or supervision with a colleague or colleagues;
- Review of relevant clinical literature;
- Review of laws, regulations, ethical standards, or secondary sources; and
- Consultation with an attorney.
In your notes, do two things. First, describe what you did to resolve the dilemma (i.e., the steps you took to decide). Second, explain why you made the decision you did. To the extent that your process and reasoning are sound, logical, and reasonable under the circumstances, you will be much safer from any claims of negligence.
The Art and Science of Compliance
Your goal is to stay above the standard of care line, all the time. This is both a science and an art.
It is a science in that it requires a systematic incorporation of specific legal requirements and ethical rules into your practice. Our system of three interlocking law and ethics CE Courses is designed to help you accomplish this, with maximum speed and efficiency.
It is an art in that remaining above the line requires sound judgment, and a nuanced grasp of the values and priorities behind the rules. Our courses are also written to help you master these principles at a deep level, and to embody them with maximum artistry.
Together, our CE Courses create a clear, easy-to-use, and comprehensive law and ethics guide, complete with model forms that are tailored to the law of your state.
We hope to see you there!