Private Practice and Technology

Authorization to release information is extremely important. You want to have a release signed by your client (in almost all cases) before you release confidential information, even when you get a legitimate subpoena. You should have such a release form ready. A release form is included in our Clinical Forms.

Businessperson: Graduate schools and supervisors generally have a single clinical focus and neither teaches that therapy is a business nor teaches how to run it. Bookkeeping, marketing, money management, rental agreements, disability, contracts, employment options, etc. are not taught in graduate school. Therapists are left on their own to figure the business aspect of psychotherapy unless they educate themselves in these arenas.

Confidentiality is the requirement that therapists protect their client’s privacy by not revealing the contents of therapy unless the client authorizes it or the therapist is mandated by the law. Be extremely careful when you discuss your clients with others. Either dis-identify them or get their written permission to reveal specific information. The release form is included in our Clinical Forms.

Driving under the influence of alcohol is one of the most common ways that therapists lose their license. Do not take this kind of risk for safety sake and for your license sake.

Errors of judgement do not necessarily put you below the standard of care or put you at risk of losing your license. Minor errors are human and are generally defensible. Consult if you are not sure about what to do (or not to do) regarding your errors.

Flexibility regarding therapeutic methods, theoretical orientation, bartering, gifts, place of therapy, self-disclosure, multiple relationships, etc. are extremely important for therapeutic alliance and successful and effective therapy.

Gifts: Giving and accepting appropriate and ethical gifts is often very important as it increases the therapeutic alliance, the best predictor of successful therapy. Gift giving is highly valued in some cultures and rejecting appropriate gifts from clients can be offensive and can irreversibly disrupt therapy.

Home Offices can be convenient, low-cost and rent-free ways to run a practice if they are done with good planning. A home office can be located in the main house or in a separate unit.

Informed Consent is one of most important forms that therapists should give to their clients prior to treatment. Informed consent is a process, not a one-time event. It should be discussed in the first session and later on in treatment, as necessary. Many therapists post it online so clients can download it prior to the first session.

Judgment in therapy should not be based on fear or on what is often taught in so-called risk management workshops. Judgment should be based on the client, presenting problem, standard of practice, diagnosis, etc.

Knowledge of the standard of care, state’s laws, code of ethics, and which therapeutic orientation is likely to be most helpful is extremely important.

Licensing Boards Investigations: Respect and honor gender diversity, especially when working with LGBTQ clients and their families and community.

Multiple relationships are sometimes unavoidable (i.e, in small or rural communities) or even mandatory (i.e., military, prison). They can increase the effectiveness of therapy, too. Do not listen to so-called experts and ethics instructors who tell you to always do your best to avoid all forms of dual relationships.

New wand younger therapists are generally more tech-savvy and are likely to be drawn to telemental health. Make sure you are well trained in the complexities involved in telemental health.

Office Policies are often part of the extremely important Informed Consent form. Office policies include basic information about reporting requirements, fees, cancellation policies, termination, methods/orientation used, and much much more. If your office policies all fit on one page, you are likely leaving out information that should be communicated to the client.

Professional wills are extremely important. They are a must-have in case you can no longer practice due to illness, death, disability, etc.

Quash: We need to remember not to automatically comply with every subpoena and to keep in mind that subpoenas may be quashed, often with help and guidance of an experienced attorney.

Record keeping is essential and keeping good records is a mandatory part of the standard of practice. Include in the records who and what you are treating, for what condition and how, termination notes and other important information. Keep the records after the last session as mandated by your state law (for example 7 years in CA).

Subpoena: When your records are subpoenaed, do not automatically send or release them to the requesting party. Do not get intimidated or pressured. Get legal advice and remember that subpoenas can also be quashed.

Terminations can be initiated by therapists, clients or both. You aren’t required to write follow-up letters or offer referrals in each and every situation. It all depends on the situation and the nature of the termination. Document who initiated the termination, what was and wasn’t achieved and seek consultation in complex cases.

Upload basic documents such as the Informed Consent form and Notice of Privacy to your web site so future clients can review, download and sign them before the first session.

Vulnerability or danger to your license: While it may not be politically correct to say it, remember what a renowned CA attorney reminded us: You are one borderline away from losing you license.

Web Site: In this day and age, you are at a deep disadvantage if you do not have an updated dynamic web site. Besides your picture, bio and CV, an informative and dynamic web site should give potential clients a close sense of who you are and how helpful you can be, as well as useful information regarding your areas of expertise.

Xero (Zero) tolerance is the rule when it comes to sex with clients and exploitation of clients.

Yelp: Do not respond impulsively to negative Yelp reviews. Take a deep breath when you see a negative or toxic review of yourself and remember that one or two negative reviews are not likely to destroy your practice. Consult in complex cases.

Zur Institute is one of the most prolific educational institutions for psychotherapists, counselors and mental health professionals. Along with 170 high quality Online CE Courses, the Institute offers a large library of free articles and resources.

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