Facing the Challenge of Liability in Psychotherapy: Practicing Defensively / Edition 2

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Facing the Challenge of Liability in Psychotherapy offers ways for therapists of all persuasions to limit liability while continuing to practice effectively. Dr. Hedges demonstrates how therapists can put themselves in a position to defend their practices if ever called on to do so-by developing a series of informed consents covering different situations, by learning how to document ordinary as well as critical incidents, by seeking out peer and expert opinion, and by using community resources as appropriate. Most importantly, Dr. Hedges points out the kinds of clinical and dynamic situations that typically lead to complaints and false accusations against therapists. This updated edition addresses three new major HIPAA regulations. A companion CD-ROM contains thirty helpful forms that can be printed out.

About the Author:
Lawrence E. Hedges, Ph.D., ABPP, is the leader of a thirty-year clinical research project into the origins of human relationships at the Listening Perspectives Study Center in Orange, California

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Editorial Reviews

...any mental health professional who practices what could be termed “psychotherapy” will find this an immensely helpful volume, especially if he or she has done no ethics reading since the final implementation of the Health Information Portability and Accountability Act of 1996 (HIPAA) or since recent court decisions have changed the landscape of practicing psychotherapy (p. 209). This is a manual for practicing as defensively as possible, without giving up your principles or delivering an ineffective service to your client. At times one is likely to disagree with the author's recommendations or feel that they are too idealistic. At the same time, it is good for psychotherapists to have an ideal to hold their practices up against. Every time the reader has an objection, I would challenge him or her to make sure there is a good reason for it because Hedges has solid reasoning and years of experience backing every recommendation. The first two chapters lay a solid groundwork for a myriad of basics that all therapists should consider having as regular practices. Time and again Hedges does an excellent job of reducing a concept to the practical issues involved and gives you a clear idea how to apply it to your practice. ...many of the risks discussed apply to the various types of therapy and can be discussed more generally. An excellent chapter points out why we need to rethink the language of dual relationships. This is important not only to psychodynamic practitioners but also to those from other theoretical perspectives. In addition, Hedges covers the required HIPAA discussion, requisite in any book of this kind, in very clear language. Each of these chapters is worth the price of the book alone, as any error you correct could save you up to a hundred or a thousand times the cost of the book retail. The materials on the CD that cover these areas appear helpful and standard, and would not require much—if any—alteration if you are a nonpsychodynamic practitioner. Thus, reading Hedges's offering should h
Bryant L. Welch
Malpractice lawsuits and licensing board complaints are a serious threat to the welfare of psychotherapists. It is fantasy to think that only the culpable are brought before licensing boards or become the targets of malpractice litigation. Being a good person and a competent therapist does not guarantee that one will not be forced to defend the profession, often with the very right to continue practicing at stake. Anyone who works with borderline patients, families, children, or very sick patients is at risk. It is that simple, and it is only at one's peril that one denies this fact. In reading Dr. Hedges' latest work, we can take a meaningful step out of the confusion that surrounds many psychotherapists today about the source and nature of their vulnerability before licensure boards and malpractice tribunals. It will be time well spent.
O. Brandt Caudill
Dr. Lawrence Hedges' book is an insightful explanation of the ethical and legal pitfalls facing psychotherapists in the new millennium. His in-depth exploration of the issues and his practical suggestions to minimize risks should help therapists avoid ethical dilemmas and possible litigation. Dr. Hedges also explores and refutes a number of popular myths about administrative and civil litigation. This book will be very valuable to any practicing psychotherapist who hopes to avoid being a defendant in a civil suit or in an action by licensing board.
Stephen M. Johnson
This book is a wonderful gift to the profession, deeply educational and eminently useful. So many of us are babes in the woods concerning the intersection of the clinical, ethical, legal, and human issues in professional practice. Dr. Hedges knows these woods and, through this book, he has made them much safer. He is uniquely qualified for this task. As a depth-oriented therapist, expert on personality disorders, and longtime consultant to therapists, he appreciates the clinical and human issues as well as the risks. As a forensic expert and educator, he has helped many of us to anticipate and handle the hazards, from the most well meaning to the most malevolent. Dr. Hedges loves these woods and I can think of no more knowledgeable and friendly guide with whom to explore them.
Martha Stark
Dr. Lawrence Hedges' latest book, the only one of its kind, is an outstandingly comprehensive and comprehensible handbook about the art of practicing defensively. Before I was even half way through the book, I was making changes in the way I conduct my practice. Hedges is eminently qualified to take on this task of educating mental health clinicians to the perils of practicing in these litigious times: he is not only a well-seasoned, highly respected senior psychoanalyst and teacher/supervisor but also the 'go-to' person for therapists in trouble with their licensing boards and/or at risk for being sued. Particularly noteworthy is the passion that fills every single page of this spell-binding volume; clearly, Hedges truly cares and is deeply committed to passing on to the reader all the wisdom he has accumulated from his many years in the field. A real page turner, this essential guide is a must-read for all practitioners interested in learning about what they must do in order to minimize their chances of having either a complaint or a lawsuit filed against them. Ultimately, however, because it gives clinicians the tools necessary to avoid what might otherwise turn into a ghastly nightmare, perhaps the worst experience in their professional lives, Hedges' book on practicing defensively empowers and holds out hope for all of us.
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Product Details

  • ISBN-13: 9780765703866
  • Publisher: Aronson, Jason Inc.
  • Publication date: 12/28/2006
  • Edition description: Second Edition
  • Edition number: 2
  • Pages: 288
  • Product dimensions: 6.43 (w) x 9.35 (h) x 0.81 (d)

Meet the Author

Lawrence E. Hedges, Ph.D., ABPP, is the leader of a thirty-year clinical research project into the origins of human relationships at the Listening Perspectives Study Center in Orange, California. Dr. Hedges travels widely, lecturing and consulting with psychotherapists on their most difficult—to—treat clients. His work on how early childhood trauma impacts the psychotherapeutic relationship has led him to a keen awareness of how the growing consumer complaint and litigational processes that surround the practice of psychotherapy today are threatening to undermine it and to destroy its effectiveness.

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Table of Contents

Foreword     xiii
Acknowledgments     xv
Facing the Challenge: Practicing Defensively     1
The Psychotherapist's Litany for the New Millennium
Facing the Challenge of Our Changing Times
Practicing Defensively: Basic Terms and Concepts     5
Ethics Complaints
Civil Law Malpractice Suits
State Licensing Board Accusations
Administrative Law Hearings
Possible Changes in Administrative Law
State Board Investigations
Responding to Subpoenas
Professional Malpractice and Administrative Hearing Insurance
Practicing Defensively: Psychotherapy Practice Issues     15
Standard of Care
Informed Consent
Diagnostic Assessment
Limiting Your Liability in Working with Children and Adolescents
Record Keeping
Releasing Confidential Information and Signatures
Practicing Defensively: Complex Treatment Issues     35
Referring for Outside Assessment
Irregular Times, Circumstances, and Places
Limit Setting
Guarding against Violations of Your E-Boundaries
Suicide Contracts and Precautions against Self-Abusive Activities
Suicide Liability Risk Management: A Summary
Accusations and Professional Apologies
When Third Parties Are in Potential Danger
Telehelp and Technology
Considering the Potential Pitfalls of Adulation of Psychotherapists
Sex and Other Relationships with Clients and Former Clients
Termination of the Professional Relationship
Minding the Mind Business     53
Managing Managed Care
Considering Incorporating
VicariousLiability and Making Referrals
Advertising Your Wares
Professional and Peer Consultation
Supervision and Employment of Students and Interns
Consultation and Training with Professional Colleagues
Legal Fees and Expert Witness Issues
Volunteer Work and Speaking Contracts
Considering a Professional Will
Arbitration and Limitation of Liability Agreements
Therapeutic Hot Spots: Boundaries, Dual Relationships, and Recovered Memories     63
The Sense and Nonsense of Boundaries
In Praise of the Dual Relationship
Taking Recovered Memories Seriously
Fully Understanding the Genesis of False Accusations
Linking Infantile Trauma, Terrifying Transferences, and False Accusations     101
Howard's Plight
Letter to the California Board of Behavioral Sciences
False Accusations and Where They Come From     119
An Imaginary Profile of a False Accuser
The Surprising Legal Success of the False-Accusation Argument
The Problem with Considering Transference-Based Accusations False
The Genesis of the Organizing Transference and the Fear of Breakdown
Trust Relationships Raise the Clamor and Set the Stage for a Fluke
Defending against Complaints by State Licensing Boards   Pamela Ann Thatcher     129
The Anatomy of the Licensing Board
Table 9-1: Administrative Claim Process
Investigation or Inquisition?
Questionable Accuracy of Witness Statements
Investigative Subpoenas: Government-Sanctioned Invasion of Privacy?
The Board as a Tool of Plaintiff's Counsel
Complaints Initiated by Investigators
Complaints by Nonclients
Investigative Reports
Documentary Evidence
Expert Witnesses
Administrative Hearsay
Settlements Prior to Hearing
Disciplinary Guidelines
Last-Minute Amendments Allowed
Changing Standards in the Profession: Dual Relationships
The Board's Unique Definition of Ownership
Sex Equals Revocation
Big Brother Is Watching
Is Reinstatement Simply a Dream?
Recovery of Costs of Investigation and Prosecution
Differences between the Defense in Civil and Administrative Matters
Future Trends
The Highest Risk Cases for Clinicians Who Work with Children: High-Conflict Divorce/Custody Cases   Steven Frankel     173
Important Attitudes For Professionals
First Problem Area: Authorization to Treat Minor Children in California
Second Problem Area: Access to Written/Verbal Assessment and/or Treatment Records of Minors
Third Problem Area: Who holds "the Privilege" for Minors?
Fourth Problem Area: Managing Demands by One Parent That Treatment be Terminated
Fifth Problem Area: Requests by One Parent (or his/her Attorney) for Letters/Testimony with Opinions about That Parent's Relationship with the Child or about the Professional's View of which Custody/Visitation Arrangements Might be in a Child's "Best Interests"
Sixth Problem Area: Sharing Information with Minor's Counsel vs. Sharing Information with Custody Evaluators
Seventh Problem Area: How to Integrate the Considerations Outlined Above into an "Informed Consent" Presentation
Ethical Risks in Child Custody: Where Is the Wizard of Oz When You Need Him?   Ira R. Gorman      189
Clarifying Roles
Evaluators as Mediators
Evaluators as Therapists
Evaluators as Consultants
Therapists as Evaluators
Clarifying Procedures
Withholding of Records
Competence to Perform Child Custody Evaluations
Psychological Testing
Convergent Validity
Proper Test Interpretation
Situational Factors
Proper Test Instruments
The Two Ewing Cases and Tarasoff   David G. Jensen     209
The Factural Underpinnings of Ewing I and Ewing II
Ewing I and Ewing II and California Civil Code Section 43.92
Does Patient Just Mean Patient?
The Kindling and the Spark: When Do I Have a Duty to Warn?
What Is Grave Bodily Injury?
Is Expert Testimony Required?
Can a Patient Be Dangerous without Ever Threatening Someone?
The Two Faces of Tarasoff
What Happened to Goldstein?
Guidelines for Compliance with Federal HIPAA Laws for Mental Health Practitioners     223
What to Do Now
The Big Picture: What HIPAA Is All About and Why We Need HIPAA
General Information
Government Enforcement and Penalties
The Three HIPAA Rules: (1) Privacy; (2) Security; and (3) Transactions
Miscellaneous Issues
Basic Forms You Must Have in Place Now
Practicing Defensively     243
Table of Contents for CD-ROM
Informed Consents and Client Information Forms
Informed Consent for Psychotherapy Assessment Consultation
Consent for Release and Exchange of Confidential Information
Informed Consent for Dynamic Psychotherapy or Psychotherapeutic Consultation (Individual, Couple, Group, and Family)
Informed Consent for Infant Relationship-Based Therapy
Informed Consent for Work with Children and Adolescents
Consent to Feed My Child During Therapy
Permission to Photograph, Audio and/or Video Record
Informed Consent for Treating Children when Parents Are Separated or Divorced
Caregiver's Authorization Affidavit
Psychotherapy Client Questionnaire
Informed Consent for a Visitor in a Psychotherapy Consultation
Informed Consent for Someone Other Than the Client to Assume Responsibility for Payment for Psychotherapy Services
Informed Consent for Telephone, Electronic, and E-Mail Contact
Informed Consent for Long-Term Psychotherapy Regarding a Case Monitor, Medical Care, and Termination Plans
Informed Consent Regarding Limited Physical Contact during Psychotherapy
Group Therapy Informed Consent
Expert Witness Agreement
Record-Keeping Forms
Chart Progress Notes (Form I)
Chart Progress Notes (Form II)
Chart Progress Notes (Form III)
Confidential Psychotherapy Note
Periodic Clinical Reassessment/Review Treatment Summary Information Guide
Special Release of Confidential Psychotherapy Notes
Letter of Request for Confidential Records
Release of Confidential Information for Purposes of Consultation, Research, Teaching, and Publication
Release of Protected Health Information (PHI)
Termination Summary
Organizing Experience Worksheet
Informed Consent Contracts for Supervision and Ongoing Training for Therapists
Informed Consent Regarding Supervision, Case Consultation, Case Conference Seminars and Individual Tutorials
Employment Agreement for Trainees
Personal References for Employment as a Psychotherapy Trainee
Section Four: Special Information and Forms Regarding HIPAA, Treating Children, Caregivers Authorization, and Family Custody
General Information on HIPAA
How HIPAA applies to the Forms with this Updated Edition Progress Note/Clinical Record
Psychotherapy Note
Release of Information for Outpatient Psychotherapy Records
Treatment Summary
Account of Disclosures
Avery Labels: Notice: This Is the Client Record
Avery Labels: This Folder Contains Psychotherapy Notes
Avery Labels: Non-HIPAA Compliant File
Treating Children in High Conflict Divorce/Custody Situations
To the Child (and presented in language the child can understand)
Caregiver's Authorization Affidavit
Family Custody Evaluation Disclosure
Disclaimer and List of Attorneys     247
References     251
Index     257
About the Contributors     265
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