Tag Archives: Professional Issues

Professional Issues

Michigan LPCs block attempt to take away their right to practice

By Laurie Meyers January 16, 2020

Your voice matters. Those who doubt the power of speaking out and advocating for the profession need only look to the counselors of Michigan. This fall, approximately 10,000 licensed professional counselors (LPCs) participated in a grassroots campaign that thwarted an attempt to take away their ability to practice.

On Friday, Sept. 13 — some would say an appropriately ominous date — Michigan’s Department of Licensing and Regulatory Affairs (LARA) released a notice of public hearing for comments on proposed changes to the state rules that define the scope of practice for LPCs. The notice served as confirmation that despite the objections of the state’s board of counseling and months of protest from local advocates, LARA was moving forward with its plan not only to change, but also to repeal, virtually all of the previous rules governing scope of practice. Most critically, the proposed changes would repeal LPCs’ practice of “counseling techniques” and ability to “diagnose and identify the problem.” In other words, LARA intended to strip away Michigan LPCs’ rights to diagnose clients and practice psychotherapy.

Absent this ability to diagnose, neither counselors nor clients would be able to seek insurance reimbursement — a devastating blow to practitioners. But the damage wouldn’t stop there. LARA’s proposed repeals would have threatened the very existence of the counseling profession in Michigan by taking away LPCs’ right to provide psychotherapy. How do counselors who can’t counsel practice? The answer: They don’t.

“The ramifications [if LARA was successful] would’ve been that 10,000 counselors would be unable to practice legally,” says Michael Joy, president of the Michigan Counseling Association (MCA). “They essentially would have lost their jobs.”

Joy, a member of the American Counseling Association and an LPC in private practice, adds that LARA’s repeal would have also left up to 150,000 clients in the lurch. With their counselors unable to practice, clients would have needed to seek treatment from other therapists. Because most of Michigan’s mental health practitioners are already carrying heavy caseloads, the search could have taken months, during which time these clients would not have been receiving help, Joy continues. This rupture in the continuity of mental health care would have been a significant therapeutic setback and could have potentially endangered clients’ well-being, he asserts. Those with more acute symptoms might even have needed hospitalization, he says.

LARA’s interest in changing the scope of practice rules for LPCs in Michigan is not new. Many veteran counselor advocates had been bracing for an official proposal for years and were working on several fronts in hopes of preventing a crisis. Although advocates attempted to work with LARA, the Michigan Mental Health Counselors Association (MMHCA) —a former division of MCA —initiated a backup line of defense by engaging a lobbyist and appealing to the state Legislature.

In March 2019, House Bill 4325 was introduced in the Michigan Legislature. Its aim was to create a statute updating the scope of practice and licensing requirements for LPCs, thus ensuring that counselors would retain their ability to diagnose and treat clients. HB 4325 would supersede LARA’s proposed changes. The bill had strong bipartisan support and was steadily making its way through the Michigan Legislature, but there were questions about whether it would pass in time.

The clock was ticking — loudly.

“Really, no one exactly knew that the trigger was going to be pulled until there was that public announcement [from LARA], and so then, the madness actually began,” explains Stephanie T. Burns, an LPC in both Michigan and Ohio and an active member of ACA, MCA and MMHCA. “LARA had made their proposals, and the Michigan Board of Counseling at that point had unanimously vetoed all the changes and, in response to that, the powers that be at LARA decided to just go ahead and put them forward anyway …”

If LARA was not swayed by the comments and testimony given at the public hearing in October, the repeal of the counselors’ scope of practice could have become effective as early as November. Michigan LPCs needed to fight hard and fast for their jobs. And they did.

A groundswell of advocacy was triggered as news of LARA’s plan spread. MCA sent out a distress signal to the American Counseling Association (ACA), whose government affairs team swung into motion. Brian Banks, ACA’s director of public policy and intergovernmental affairs, began strategizing with MCA to formulate a plan. ACA sent out a VoterVoice email alert — which guides subscribers through the process of contacting legislative representatives on federal and state issues — to its members in Michigan. The ACA government affairs team expanded the call to action by posting advocacy alerts targeting all Michigan counselors on Twitter and Facebook. ACA also reached out to the Michigan branch of the National Association of Social Workers, the Michigan Primary Care Association and the national offices of the National Alliance for Mental Illness and the American Federation of State, County and Municipal Employees. MCA began circulating a petition and lining up members who were ready to testify at the LARA hearing to the countless clients they had helped and the lives they believed they had a hand in saving. MMHCA also urged members to testify at the hearing in person if possible or, if not, to email their written testimony to LARA before Oct. 4.

In the meantime, Burns, an associate professor of counselor education at Western Michigan University, began spreading the word among alumni and colleagues about the threat to all LPCs and the urgent need to contact LARA and state legislators. In addition to engaging in her own advocacy work, Burns teaches her students how to advocate effectively, so she had already formulated action steps and language — posted as a template on MMHCA’s website — for email and letter appeals.

Thousands of counselors responded to the call to action ahead of the hearing, pelting LARA with protests and urging their representatives to move forward and approve HB 4325. And on Oct. 4, counselors bombarded the hearing. In fact, the turnout exceeded the venue’s fire code restrictions, so not everyone who showed up was able to come inside, according to Joy.

Banks attended the hearing to present ACA’s testimony, written by Chief Executive Officer Richard Yep.

“ACA wants to support our members and the profession at the highest level,” Banks says. “Being in Michigan to support the profession was a vital step in showing LARA and the Legislature how important these issues are.”

ACA’s statement emphasized the critical role that LPCs play in providing mental health and drug abuse treatment to the residents of Michigan. Preventing counselors from treating clients would greatly exacerbate the shortage of mental health providers, particularly in rural areas of the state. In addition, LARA’s actions would have created a violation of ACA’s code of ethics, which requires that counselors make a proper diagnosis before providing treatment.

Burns also focused on the ACA Code of Ethics in her written messaging and when meeting with the Michigan Senate Health Policy Committee. She specifically referenced the part of the ethics code that says professional counselors cannot abandon or neglect their clients. “I said [to the committee], ‘LARA will be responsible in that moment for causing harm — serious harm — to our clients.’”

In the end, the combined efforts of MCA, MMHCA, ACA and — most importantly — thousands of counselors from across the state paid off. In October, both houses of the Michigan Legislature voted unanimously to pass HB 4325. On Oct. 29, the bill was signed into law by Gov. Gretchen Whitmer.

Burns and Joy both praised ACA for its assistance, in particular noting its decision to send Banks to testify in person at the hearing rather than merely submitting the statement from afar. Joy adds that the knowledge he gained at ACA’s Institute for Leadership Training helped him to form an effective course of action for MCA.

“Michigan is a perfect example of how grassroots advocacy works when effectively organized,” says Banks, adding that the campaign was one of the strongest he’s seen in his 20 years in the field.

Sometimes it takes a Michigan-sized crisis to spur large-scale grassroots efforts. But Burns and Banks urge counselors not to wait. The profession is facing numerous critical issues — such as the fight for Medicare reimbursement. Lawmakers and regulatory officials will make decisions about the profession with or without counselors’ input, Banks emphasizes.

“We have to have a seat at the table.”

 

****

 

Laurie Meyers is senior writer at Counseling Today. Contact her at LMeyers@counseling.org

 

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Hey, Siri: Did you break confidentiality, or did I?

By Nicole M. Arcuri Sanders January 14, 2020

Did you know that your tech devices have the potential to break your clients’ confidentiality just by being in the counseling setting with you? Imagine that you have worked a full day seeing an array of clients for the various concerns they are facing. Then, at the end of the day, you snuggle up on the couch and scroll through your phone’s applications. You notice numerous ads and suggestions that relate to the topics clients have shared. For instance, imagine a client sharing about a traumatic event that happened in the Catskills, and now you have Airbnb suggestions for that area, along with resources for dealing with sexual abuse.

You may be wondering, “How did that happen? Was my phone listening to our session?” The answer might be yes.

In other cases, you might not be made aware that your phone was listening, but it is important to know that it has that capability. The reason for this is the voice assistant technology on your devices. While on, these devices are constantly listening. For instance, Apple iPhone is listening for the word “Siri”; anything said after that is considered a command. The same is true with Amazon’s voice assistant Alexa and with Google Assistant. Each of these devices is waiting for its name to be called so that it can follow up with whatever assistance the person using it desires.

However, it has been found that the devices sometimes mistake certain words and are activated unintentionally.

This past July, The Guardian newspaper shared shocking reports from an Apple contractor. This whistleblower reported that Apple contractors “regularly hear confidential medical information, drug deals, and recordings of couples having sex, as part of [Apple contractors’] job providing quality control.” These workers are tasked with listening to grade the responses of the company’s Siri voice assistant. For example, the workers will grade if the response from Siri was accidental or deliberate and if Siri’s response was appropriate.

But what does this mean for professional counselors? Just think invasion of privacy and breach of confidentiality concerns.

Voice assistant concerns in the counseling setting

This next section is going to present a hypothetical counseling office to address some of the confidentiality concerns that surround the counseling experience with technological voice assistants. Consider whether you address these concerns in your informed consent with clients. Would these occurrences align with Health Insurance Portability and Accountability Act (HIPAA) regulations?

Waiting room: Counselors strive to create a warm and inviting setting to foster a comfortable feeling for clients because they are in a vulnerable situation. Perhaps some relaxing music is playing in the waiting room. Consider Alexa being programed to shuffle through various playlists of calming songs throughout the day.

As clients await their sessions or end their sessions, they may need to discuss billing with the front-desk assistant or call their insurance companies. Clients may even take a call during this time for other purposes. Alexa hears all of these conversations throughout the day. Therefore, the potential is there for the entrance to this “safe place” for clients to instead become a place where personal information is leaked to Alexa and to those who monitor Alexa or have access to Alexa’s recordings.

Additionally, clients may not even realize that while they are in your office discussing billing, diagnosis, and plans moving forward, their smartphone’s voice assistant can be eavesdropping as well. The same goes for all of the other smartphones located in the waiting room, including those being used by personnel working the front desk.

In session: When clients and counselors meet in an office, safety is a concern. Therefore, counselors may choose to keep their phones in their pocket or nearby in case they need to call for help. Some sites may even have a policy requesting that counselors have their cellphones on them at all times. However, now these phones’ voice assistants can have access to the dialogue that occurs within the room. This also means that whoever is monitoring the voice assistants have access. What was intended to be a safe place for clients to navigate and process concerns is now compromised.

Can you imagine if you, as the counselor, were facilitating a group and each client had a smartphone with a voice assistant? Consider also if you take notes on an iPad that has voice assistant technology. As counselors, we understand there are some limits to confidentiality. However, these voice assistant technologies have the capability to leak what clients and counselors once believed to be confidential information.

 

Disconnect: Don’t be considered liable

A number of considerations need to be taken into account by both the counselor and the client regarding confidentiality of sessions when voice assistant technologies are present. First and foremost, this issue should be addressed. Now that you are aware of the implications for your practice, you are ethically responsible for addressing these possibilities with your clients.

According to the 2014 ACA Code of Ethics, clients have the right to confidentiality and an explanation of it limits (Standard A.2.b.). Understanding these limits, clients have the right to make an informed decision regarding whether they would like to participate in counseling services with you (Standard A.2.a.).

Therefore, if you choose to utilize voice assistant technologies, you need to inform clients of the benefits and risks prior to them beginning counseling services. This explanation is not limited only to the counselor using these technologies but also acknowledging whether the counseling site allows its staff or clients to use them. If your site chooses not to utilize voice assistant technologies, you will need to address what your protocol is concerning this matter. For instance, will all cellphones be turned off? How will this be regulated?

What if your site requires cellphones for safety concerns or if clients are not willing to turn their phones off? How can you still protect client confidentiality and be in alignment with HIPAA regulations? The simple answer is to turn off your voice assistant technologies. You might consider noting the confidentiality risks in your informed consent and then sharing some of the directions noted below for how to disable these technologies.

 

*****

 

For iPhones and iPads, to turn off Siri, complete the following directions:

1) Open your settings.

2) Click Siri and Search.

3) Toggle OFF, listen for “Hey Siri.”

4) Toggle OFF, Press Home (or side button) for Siri.

5) Toggle OFF, allow Siri when locked.

 

*****

 

To turn off “Hey/OK Google,” complete the following directions:

1) Open your settings.

2) Under Google Assistant, tap Settings again.

3) Under Devices, tap Phone.

4) Turn OFF Access with Voice Match/Assistant.

 

*****

 

To turn off Amazon Alexa, complete the following directions:

1) Open your settings.

2) Select Alexa Privacy.

3) Tap Manage How Your Data Improves Alexa.

4) Turn “Help Improve Amazon Services and Develop New Features” OFF by tapping the switch.

5) Confirm your decision.

 

*****

 

These steps can provide clients with a choice while also informing them of the risks of their choices. In group counseling, however, as a safeguard to clients’ confidentiality, I would recommend not allowing any client to keep their cellphones, iPads or any other voice assistant technologies on.

Because these devices may travel with us basically everywhere we go, our conversations are being monitored for product improvements, but in the process, our confidentiality is being breached. Currently, with some simple options for turning off these technologies, clients can continue to maintain the level of confidentiality to which they originally thought they were agreeing.

As counselors, we take many safeguards to protect our clients’ confidentiality. I encourage you to toggle off your voice assistant technology options to keep your devices from being the reason you are held liable for breaking confidentiality. Moving forward, as technologies continue to transform, we as counselors need to be ready to address implications in the counseling setting.

****

Nicole M. Arcuri Sanders is a licensed professional counselor, national certified counselors, approved clinical supervisor, and core faculty at Capella University within the School of Counseling and Human Services. Contact her at Nicole.ArcuriSanders@capella.edu.

 

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Grieved: A firsthand account of enduring a client grievance as a counselor

By Jessica Smith January 7, 2020

I learned in graduate school that most counselors will experience three things in their careers: a client who dies by suicide, a client who overdoses, and a client who files a grievance. I remember hoping that I would be the exception to the rule. Throughout my career, I tried to do everything in my power to avoid that grad school prophecy. But fate had other plans: Last year, one of my clients filed a grievance against me.

Shame breeds in secrecy. In my experience, being the subject of a client grievance is one of the most shaming — and isolating — events a counselor can encounter. Those who choose to speak openly and honestly about the grievance process are often met with judgment and criticism. In an effort to help combat the silence and stigma, I’m sharing my story with the hope that it will provide guidance and support to other counselors who are going through this difficult and trying process. I want to remind others that they are not alone on this journey while also offering a road map for a way through. It will be OK.

One of the things that helped me get through the grievance process was conceptualizing it in terms of Elisabeth Kubler-Ross’ grief cycle. I tell my clients that the stages are the road map for grief. If I had a road map, then I had a direction to go, and I was not stuck or lost. I did not know when I would reach acceptance, but I knew that it was on the horizon if I just kept moving forward.

 

Denial and shock

Early last year, while checking my email in a Target parking lot, I saw a message from the Department of Regulatory Agencies (DORA) sitting in my inbox. In Colorado, DORA is the governing body that issues licenses to providers while also handling consumer grievances. My heart began beating quickly. I felt dizzy and nauseous. I walked into the store to return an item at the customer service counter, and I had to will my legs to move forward and my mouth to speak. I felt like everyone around me could see a massive letter “G” tattooed across my forehead. My hands began to shake as I drove home so that I could read the email at my desktop computer. As I read through the entire message from DORA, I started to cry.

A few weeks prior, I had taken on a new client at my practice. Interestingly, my intuition immediately suggested that this client would be challenging. The second session reinforced my sense that building a therapeutic relationship with this client was going to be a rough road. The third session didn’t happen — the client was a no-show, no-call. When I reached out to the client through a text message, she said that she did not want to schedule a future session with me, so I discharged her from therapy that afternoon. I had a feeling this would not be the last time that I heard from this client. My intuition was correct.

I received an email from the client that night, criticizing me for the way I had handled the interaction. She thanked me for helping her but asked me to explain my “side of the story.” Because I had already discharged her from therapy and felt that any potential future counselor-client relationship would be negatively impacted by the exchange, I told her that I no longer felt comfortable working with her. Again, I had a feeling this would not be the last time I heard from this particular client. My intuition was right again.

 

Bargaining

DORA was citing me for poor communication and abandonment. I immediately reached out to a friend and former colleague who had worked with an organization that completed assessments for DORA. I knew she had also been through the client grievance process a few years prior. As I prepared for our discussion, I looked up everything I could find on the internet about the grievance process, client abandonment, HIPAA, and mental health statutes. Nothing was clear, and most of the information seemed contradictory.

On the phone, I laid out the facts of the case before my friend. Like many others I would talk to along the way, she thought it likely the case would be dropped. Thankfully, the grievance was not based on a verbal exchange; resolving the case would not depend on pitting my word against the client’s. My friend advised me that I might need to seek legal counsel, and we discussed my official response to the complaint, which I typed up immediately and sat on over the weekend.

The following Monday, I gathered the client’s file and submitted it to DORA, along with my response to the grievance. I also reached out to my insurance carrier to let it know about the grievance. All the while, I was hoping the case would be dismissed so that this nightmare would end. Due to the benign nature of my case and the cost, I chose to hold off on hiring legal counsel at the beginning, but my insurance provider encouraged me to reach out to a lawyer if the case continued any further.

 

Depression

The grievance was all I could think about. It consumed me. I would fall asleep ruminating about it and wake up the next morning to a continuation of my thoughts from the night before. Or, just as often, I would wake up in the middle of the night, my anxiety quickly rising as I remembered that this was not a dream — it was really happening to me. I prayed for it all to go away. I wanted to return to a sense of normalcy. I began second-guessing myself and the image I was presenting to my clients at work. I felt on edge and afraid that something else would happen. I feared that this grievance process would not be the end of it.

I had been in the field for seven years and had never experienced an issue like this previously. I had provided services in challenging and demanding settings, including detoxes, residential treatment facilities, and jails, and I had never before had a client complain to a supervisor or another colleague about my work.

Because the personal is professional and the professional is personal in our work, it can be hard to separate the two. This makes it difficult to prevent internalization during the grievance process. I felt like a bad counselor and, thus, a bad person. At the same time, I felt confused because I had other clients telling me that I was an incredible therapist who had helped them change their lives for the better and become the best versions of themselves. I tried to hold space for all of these experiences and live in the gray, but it was tiresome and tough to do.

Fearing judgment and criticism, I was mindful of who I shared my troubles with. I was in a vulnerable place and was already attacking and beating myself up enough without someone else adding to the punishment and suffering. Like most therapists, I am attuned to nonverbal cues and underlying speech tones and was always looking for them when I told my story to fellow counselors. For the most part, I chose to keep the experience to myself and a few confidants, but I knew that wasn’t enough. I also needed the perspective and guidance of other professionals during this demanding time, so I shared with people in my therapist support groups. The majority of the people I told were empathetic, nonjudgmental and supportive, but there were a few whose faces dropped once I told them. There were still others who tried to use my story as their own personal case study, which was disappointing and disheartening.

I felt like I was in a dream, observing this entire experience happening to me from a distance. I believe that, at the time, this was a necessary coping strategy. I had to compartmentalize the experience so that I could go to work each day and meet with clients at my private practice. I likened it to being sued by your company and continuing to show up for work every day, knowing what is happening around you and within you.

I questioned myself constantly and considered what I could have done differently. I read through the mental health statutes and searched HIPAA forums, but nothing was transparent and straightforward. I tried to look up articles, podcasts and research on the grievance process but could find only one research article from the 1990s on the impact of the grievance experience on psychologists. It helped to know that my experience of the process was normal and valid, but it did not ease my fears.

 

Anger

I have two licenses in Colorado, which is advantageous in my work — except for when I going through the grievance process. My double licenses made it doubly difficult because my case had to go before both boards. The two licensing bodies can have differing opinions and sanctions, but I learned early on that once one board reaches a verdict, the other board often follows suit. I received an email informing me that the Colorado State Board of Licensed Professional Counselor Examiners would be the first to review my case, in May. I had submitted my paperwork in February, so it would be months before I would know the resolution of my case. I was learning that the grievance process is a prolonged waiting game.

Meanwhile, I was expanding my practice and interviewing contract therapists. Then, in April, I received an email from the Colorado State Board of Addiction Counselor Examiners informing me that my case had gone before its board first, without my knowledge. I was blindsided. I was in the middle of doing interviews but, thankfully, had a break, so I drove home. I made it about halfway before pulling over to the side of the road to read the rest of the email. My mind was blown. I felt like my sense of reality was crumbling.

The Board of Addiction Counselor Examiners had found me “guilty” of the allegations and was moving the case forward to Colorado’s Office of Expedited Settlement. I found a lawyer online and emailed him from the side of the road. I felt powerless and out of control and needed to find a way to regain my sense of self-agency. I knew that taking action was the way for me to do that. I didn’t want to have any regrets about what I could have or should have done, so I was finally ready to get legal assistance for this fight.

I met with the lawyers the following week and learned that they were receiving three to five grievance cases per day. In the past, they said, they had received only three to five grievance cases per month. After our meeting, I looked up the list of therapists involved in disciplinary actions through DORA’s website, and the numbers were staggering. There are approximately 26,000 counselors in Colorado, and more than 11,000 have received disciplinary action.

I was angry — with myself, with the system, with the profession, and with the client. I felt so much anger pulsating through me that I wanted to scream and to run away, both at the same time. I thought about walking away from it all — leaving the counseling profession, giving up my licenses, and moving on to a different, safer, easier path.

Mainly I thought, “Why me?” I felt myself moving into a victim mentality as I had done in the past when going through trying experiences. Because I have been victimized in my past, this is an easy role for me to assume when I am experiencing pain and suffering. I blame others and shut down.

Anger is an uncomfortable emotion, but I knew I was meant to have it in this moment because it would lead to motivation, change and movement. I could harness it or let it eat me alive. It was my choice alone.

 

Acceptance

Like many grieving people, I remained stuck for some time in the anger phase. Anger feels powerful and motivating, unlike sadness, which is exhausting and debilitating. However, I always go back to the saying that “anger is like taking a cyanide pill and hoping it will kill your enemy.” It only ends up hurting you in the end. My anger toward myself, the client, the system and the profession would not serve me. It would end up eating me alive if I allowed it to.

I was walking home from work one day when suddenly it began to rain. Completely unprepared, I had nothing to keep me dry. It was only a mild shower, however, so I said out loud, “If it keeps raining like this, then I’ll be OK.” It started raining harder. Undaunted, I said again, “If it keeps raining like this, then I’ll be OK.”

And then it began to pour. I was halfway home, caught in a storm without a raincoat. All I could do was surrender. I was broken open. The armor of anger I had been parading around in fell away as I began to cry. “I surrender,” I said aloud. “I get it. I’ll always be OK.” I started to smile as tears mingled with the raindrops running down my face. Nature has a way of asking us to let go of our resistance and surrender.

I released my anger in that moment, realizing that I’d been aiming most of it at myself. I began the slow process of forgiving myself and coming back home to the idea that we are all doing the best we can. I never meant to hurt the client, and I had no malicious intent in my actions. I had done the best I could in that moment and with the situation.

I moved into acceptance by making meaning of the experience and discovering that it was meant to realign me with my soul’s calling and purpose. I realized that I cannot veer far off my course in life before the universe pushes me back into my lane.

 

Lessons learned: Seek support, ask for help, find allies

It is difficult to share with others what it’s like to go through the grievance process, but it is also incredibly necessary. As is the case with any grief process, we need sources of support to call on to ground us and anchor us when we feel like we are floating away or losing sight of our true selves. As professional counselors, we may make mistakes, but that does not make us bad people. We need to be reminded of our goodness and wholeness.

It is essential to surround ourselves with genuine and unconditional love and to have a safe place to cry and yell without fear of judgment or criticism. When all we want is to lie on the ground and give up, our support systems can lift us up and keep us moving forward. And, finally, we need to be reminded that counseling is extremely difficult work.

My only regret about the whole process is that I did not seek legal counsel sooner. I wonder what might have happened if I had not been deterred by the nature of my case and the cost. Although I now realize that I needed to go through this process to realign my priorities and path both personally and professionally, I sometimes question whether things would have turned out differently if I had sought the assistance of a lawyer in formulating my response to the grievance originally.

Retaining attorneys earlier in the grievance process might not have helped me avoid the verdict of “guilty,” but it likely would have provided me more peace of mind. In fact, once I sought legal counsel and spoke with my lawyers, I felt a sense of ease and relief. As I mentioned, I was restless and waking up frequently during the nights, but after that initial afternoon meeting with my lawyers, I got my first full night’s sleep in two months. I am aware of how vital regaining the ability to rest was to enduring the trauma of the grievance process. Sleep heals.

Later on in the process, I connected with the Colorado Counseling Association (CCA). I remember saying to myself, “DORA protects the consumers, but who protects the counselors?” This was my answer. I went to an event sponsored by CCA and learned more about the advocacy work it does to support and help counselors. Specifically, it is fighting to change the vague and subjective language of the clause in the mental health statute of “best practices” that was cited in my case and many other cases as a catch-all category for disciplinary actions. Here were even more people on my side who were passionate about advocating for counselors and changing the system.

During the grievance process, someone had said to me that the tower I had built with all I had believed to be true was crumbling and falling, leaving behind a pile of rubble and debris. My beliefs about my career had been built on shaky and rocky ground to begin with, so it was inevitable that they would all come tumbling down eventually. Now that the collapse had ended, I had to decide what to do with the debris. I could choose to walk away from the bricks and stones in the rubble, or I could use them to build a new tower on stronger ground.

I am still in the process of rebuilding, and I know that it will be a slow and methodical project. I am fulfilling the stipulations from DORA and considering the future. I am not sure if I will ultimately want to maintain both of my licenses. For now, however, I have chosen to keep them. But I know that the choice is mine — no one else’s. I now have a solid foundation on which to build my tower.

With each placement of brick and stone, I feel stronger and more powerful than I was before this experience. My battles scars and wounds will influence how I build my tower, but they will not halt or control the construction. As Carl Jung said, “I am not what happened to me; I am what I choose to become.”

 

****

Jessica Smith is a licensed professional counselor and licensed addiction counselor with a private practice, Radiance Counseling (radiancecounseling.com), in Colorado. Contact her at jsmith@radiancecounseling.com.

 

****

 

ACA members: Facing a dilemma about ethics, business practices or risk management? Contact the ACA Ethics and Professional Standards Department at (800) 347 6647, ext. 321 or email: ethics@counseling.org

 

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: The boring (and risky) part of the job

By Gregory K. Moffatt December 23, 2019

I spent almost 10 years as a lecturer at the FBI National Academy in Quantico, Virginia. The very best of the best from every possible area of forensic science were clustered together in the behavioral science unit deep underground on sublevel two.

I learned a lot from my colleagues in those years, but the most memorable thing I heard while I was there was this: “Agents will get themselves in far more trouble with their pens than they will with their guns.”

Written documentation lasts forever, and poorly written documentation can cost you your job. Most agents never have to take their guns out of their holsters through most of their careers, but every one of them will write hundreds of pages of reports over the course of 25 or 30 years. That is a very long paper trail, and it provides plenty of opportunities to do it wrong.

The counseling profession is much the same. I like to believe that most of us will never get in trouble for egregious ethical violations — the equivalent of an unauthorized shooting in law enforcement. But all of us will, like my FBI friends, write hundreds of pages of reports over the course of our careers.

We will file insurance documentation, create case notes, develop treatment plans, and perhaps write excuse notes to employers, teachers, colleges and other important people in the lives of our clients. Some of us will provide written statements to the court, child protective services, and other government agencies.

Most of our documents will never be seen by anyone other than us, our staffs, and perhaps insurance company employees. But sometimes, others will see our written work.

Once when I was consulting with a business, the company employee assistance program representative had required an employee to seek a mental health evaluation to ensure the employee was not a risk to self or others at the worksite. The written report from the psychologist was more than two pages long and full of opinion and subjective commentary about the client. But the worst part was the first sentence: “I declare that the employee is sane.”

Sanity is a legal term, not a mental health term. If the case involving this employee had gone to court and the psychologist had been questioned on the stand, the first thing a lawyer would have done would be to drop the Diagnostic and Statistical Manual of Mental Disorders on the bench and ask the psychologist to flip to the page where “sane” shows up. It isn’t there. The psychologist would have, at the very least, looked incompetent.

Likewise, to declare someone “sane,” ethically one must have training and expertise in competency evaluations. Because this psychologist apparently didn’t know the meaning of the word, I suspect she did not possess the requisite training. A single word on a more than two-page letter could have created major troubles for this psychologist with the ethics committee of her licensing board.

It’s likely this psychologist had never written such a letter before and didn’t think to run it by a colleague before sending it. That was risky. An otherwise (what I can assume to be) stellar career could have been derailed by the pen.

With this in mind, I propose five simple rules for counseling professionals:

Rule 1: If you don’t have to write it down, don’t. The letter from the psychologist could easily have been limited to one sentence: “I do not find this client to be a risk to self or others.” That was the mandate and all that the company wanted to know.

Rule 2: Be objective. What do you see or hear that is clear, pertinent to the case, and that another therapist sitting in the room would also see? Avoid adjectives and modifiers. The psychologist wanted to help her client, but her personal feelings about the client were irrelevant in that situation. Another therapist in the room might have had different feelings.

Rule 3: Use professional and clinical language carefully. “Sane”?  Really? If you haven’t diagnosed depression, for example, don’t say that a client is “depressed.”

Rule 4: Assume someone else — a judge, a jury, a licensure board member, an attorney — might someday see what you have written. Don’t write anything that you would be ashamed or embarrassed for someone else to see.

Rule 5: If you don’t have one already, find a mentor who can help you polish the writing part of your career.

I was trained as a person-centered counselor and, consequently, kept very few case notes. Looking back, I’m embarrassed at what I produced in those days when I was beginning to learn the art of writings things like progress notes. Today things are much different, and I’m hopeful this word of caution will help you get there quicker than I did.

 

****

The impact of internet self-disclosure on the counseling relationship

By Laurel Shaler December 16, 2019

It was only our third session, but “Anne” and I seemed to be connecting well. She was thrilled to finally have time for counseling, given her busy life as a stay-at-home mom to three young boys and with a husband who traveled extensively. Over time, Anne began to relax and feel more comfortable opening up about some of her painful past experiences. She started sharing that one of the particularly challenging times in her life involved her and her husband’s struggle to conceive.

As soon as the words were out of her mouth, however, I could almost see her wrestle to pull them back in. She stumbled to recover but seemed to be saying that she had no right to complain about their journey to parenthood because “at least” they had been able to have children. As my mind began to process what was happening, it hit me: She has seen my website.

Anne was one of my first clients after I opened a small solo practice. After leaving my previous clinical position and moving into counselor education, I had created a website on which I posted blogs and links to online articles I had written, listed speaking topics, provided links to videos as well as radio and podcast interviews, and shared about my books. Anyone who reviewed my website and read about me would learn that a part of my journey had been through infertility.

There was always a risk that students would search my name on the internet and come across my website, but that was a risk I was willing to take because I felt called to reach out to the community at large regarding topics related mostly to emotional well-being. Along the way, I shared a bit of my story.

When I opened my counseling office, I included the information about my practice on my website, but it did not occur to me that clients would review the website and bring what they found into the sessions with them. I knew that I would never be “friends” with clients on social media, nor would I search for my clients on the internet, and I included that information in my informed consent. But Anne’s reaction to her own vulnerability helped me realize that my internet self-disclosure was having a negative impact in the counseling room and that it might impact future clients as well.

Soon after my interaction with Anne, I consulted with another counselor regarding next steps. I did not want to shut down my website or stop speaking and writing, but I also did not want to cultivate an environment where my clients were so concerned about me that they filtered what they were saying so as not to hurt me (based on their own ideas regarding what would hurt me, that is). The counselor with whom I consulted had one suggestion: Separate my one website into two, with one being a personal website and the other a practice website.

I saw numerous flaws with this solution. First, I could not manage (or hire someone to maintain) two websites, especially with my private practice being very small. Second, a client could still easily locate my personal website by performing a simple internet search. (After all, the name “Laurel Shaler” is not a common one.) I thought there had to be another option for addressing this dilemma. I began to realize I could do several things to mitigate the effects reading my website might have on my clients, but at the same time, there were certain things I could not control. The same is true for any of us who self-disclose on the internet.

I cannot control a client searching for my information online, for instance. Because I have something of a public presence given my public social media accounts, trade books, and blogs/articles on the internet, clients are likely to run across some information about me that goes beyond the scope of my private practice. I have to be OK with that to maintain both an online presence and a clinical practice. Likewise, my clients need to be aware of the pros and cons of learning more about me over the internet.

What it will really come down to is the same factor that affects every counselor-client relationship: therapeutic rapport. If my client and I can establish safety and trust, as well as appropriate boundaries, and can communicate effectively, then we can more than likely work through whatever may arise as a result of the internet self-disclosure.

Through a self-supervision process, I have come to realize that Anne may have overidentified with me. In other words, in the same way she might not want to hurt the feelings of a friend, she did not want to hurt my feelings. She assumed that because I had been through an infertility journey that did not result in biological children, that sharing her journey that did result in biological children would upset me. Although I did not address the issue head-on at the time, if given a second chance, this is what the communication might have sounded like:

Anne: I shouldn’t complain because I know not everyone can have children, and I am really lucky and fortunate and blessed to have children even though I did go through infertility. I know it’s not the worst thing in the world, and others have a much harder time than we did. I shouldn’t have said anything about it.

Laurel: It sounds like even though you are grateful that your infertility journey ended by having children, that you had a hard time going through that experience. Can you help me understand why you think you should not say anything about your infertility?

Anne: Well, to be honest, I read on your website about your infertility journey, and I am so, so sorry for what you went through. I don’t want to compare my story to yours, in particular since I was able to have children and you weren’t.

Laurel: Your sensitivity to me says a lot about who you are as a caring and compassionate person. At the same time, I want this to be a safe space for you to feel free to openly share about your entire story. I want to encourage you to hold nothing back on account of me. You are welcome to read what I post — keeping in mind what you read may impact your view of me or our counseling relationship.

Anne: Yeah, I like what you write but did not want to offend or upset you.

Laurel: Thank you, Anne. I do not believe I will be offended or upset. However, if I am, that is my own issue that I need to work through with a counselor or supervisor. It would not be your fault. Are you open to exploring the infertility issue and the turmoil that brought to your life and marriage?

Anne: Yes, because it really messed me up for a while and my relationship with my husband too.

Laurel: OK, please start wherever you would like.

Anne: It all started …

Obviously, this fictional dialogue could go many different directions. This is a good-faith guesstimate of how the conversation might have unfolded based on the relationship I had with the client at the time.

In reality, even though I was a bit flustered internally and did not address head-on the client learning about me online, we were able to move forward with our therapeutic relationship. Anne came regularly to see me for about six months before she and her husband decided to pursue marriage counseling, at which time she needed to pause individual counseling.

My personal takeaways from this experience were twofold:

1) Counselors must think thoroughly and carefully about how having an online presence might impact their counseling practice and the clients they are serving. Counselors have to decide whether the two are compatible and if they can still be effective counselors. Is there controversial content that may lead a client to feel uncomfortable with the counselor? Is the counselor something of a “celebrity,” leading clients to be a bit star-struck and concerned about disappointing the counselor? Numerous aspects of internet self-disclosure need to be considered. Additionally, counselors must decide how to navigate the two or more hats that they wear. For example, counselors must decide whether to have two separate websites or one website that incorporates both a personal/commercial side and a counseling practice side.

2) If counselors have an online presence, this should be addressed early on in the counseling relationship. This can be part of a written informed consent, along with other information regarding the counselor not searching for clients online, not accepting or sending friend requests on social media, etc. This can also be addressed verbally in session, wherein counselors discuss their online presence and talk through how a client’s review of the counselor’s internet information might affect the counseling environment. Counselors must be aware that disclosing their online presence is, in and of itself, self-disclosure. Therefore, as with all self-disclosure, this must be addressed solely for the benefit of the client.

There is absolutely a way to have both an online presence and a successful counseling practice. Many counselors have done so beautifully. My personal experience taught me a valuable lesson about how these two can work in tandem rather than against each other. Anne — like all clients — deserved to have an authentic counselor with whom she could truly be transparent, without filtering herself based on information she knew about the counselor.

Although I believe knowing less about the counselor can be beneficial to clients, I am well aware that in our internet-driven and instant-knowledge society, many clients will desire to learn all they can about us before, during and after the counseling process. Getting out ahead of potential problems that could arise as a result may prove helpful for clients. Because my online presence is not going anywhere, this is an ever-evolving process that I must pursue for the sake of my clients.

 

****

Laurel Shaler is a licensed professional counselor, national certified counselor, and licensed social worker. She is an associate professor in the Department of Counselor Education and Family Studies at Liberty University. Contact her through her website, drlaurelshaler.com.

 ****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.