Law & Ethics as a Mental Health Provider

Welcome to this week's blog post.  Today I'm simply sharing what's on my mind after attending a full day training on Law & Ethics in Youth Services and Child Welfare.

This past week I attended a full day of Law & Ethics for Youth Services & Child Welfare, via Zoom, no less.  Sounds riveting, doesn't it.  Well, I agree.  Usually a full day training of Law & Ethics is dry and boring, but mandatory for mental health clinicians to keep their license.  So, a necessary evil, of sorts.  However, this training was much different and much more interactive, keeping me engaged far better than any previous Law & Ethics trainings I've attended.

Some of the topics that I have regularly struggled with, came up during this training, and the responses from the other attendees was interesting.  Such vignettes as:

    "Your client is selling Girl Scout cookies and has an ambitious goal.  She asks if you will help her out  and buy a few boxes?  And asks if you could also ask your friends and family or post on your social medial for her?"

The responses ranged from clinicians who would buy a box (or maybe a couple), since they want the Girl Scout cookies anyway and it helps their client toward their goal, but would NOT ask friends and family or post on their social media.  Some responses were an immediate NO to all of it...they wouldn't buy any cookies, ask their friends and family, or post on social media.  So we had some discussion about everyone's responses.

What is important to keep in mind, is that much of the appropriateness of the response depends on the kind of professional relationship you have with the client.  For example, if you are a mental health worker in a girls' group home, and one of the girls asked you the questions in the vignette above, then an appropriate response is NO, because you have to be fair and equitable to all the girls in the group home, not showing any preferential treatment.  And it would then warrant some discussion with the girl about why it's not appropriate and would provide an opportunity for a teaching moment.

But, if you're a solo private practitioner, seeing clients individually in your office, it might be completely reasonable to buy a box or two of cookies.  And would lend to additional conversation with your client about the importance of boundaries.

But in general, Law & Ethics has always been somewhat of a struggle for me, not because I'm an unethical person, but because my ethical standard is often a little different from those of the Board of Behavioral Sciences.  Having worked in public Child Welfare for for over 20 years, I recognize the the huge importance of engagement and relationship building with clients, as a means to improved outcomes.  The same definitely holds true as a therapist.  

For me, I have to use my personal judgement on a case by case basis, to determine what is most appropriate AND ethical when it comes to interactions with a client.  And I have to get to know each client to determine this.

This leads to another somewhat ethical dilemma I faced recently.  In working in a bureaucratic mental health position, proving individual counseling to people, I am required to provide a diagnosis, even after the initial intake session.  For me, THAT doesn't seem ethical.  I am being forced to pigeon-hole or label someone, before I've even had the chance to get to know them or even start to understand what's going on for them.  But in order for them to receive services through their insurance, there MUST be a diagnosis.  And then, to top it off, there are only certain qualifying diagnoses.  For me, this puts me in a difficult situation, in which I must label a client, before I have really had a chance to fully assess them, their issues, and their current status.  So, I am learning how to be creative in my diagnoses, so that I don't incorrectly label a client to quickly, but so the services they so desperately need, can be covered by insurance.  It's a ridiculous game we have to play in bureaucratic mental health care, so I have to step up my game playing skills a bit, in order to best serve my clients.  Seems a little counter-intuitive, doesn't it?

But this also leads to something I am grateful for, and as a mental health therapist, I strongly believe in the practice and benefits of daily gratitude.

I recently purchased my copy of the DSM-5, because, again, working in the mental health bureaucracy regarding diagnoses, I realized I needed it.  If I was going to play this qualifying diagnosis game, then I might as well properly equip myself.

So, as I've been reading through some of the diagnoses in the DSM, especially as they relate to some of my clients, I realized that this "game" is causing me, forcing me to get back to basics and in touch with the current diagnostic criteria for mental health issues.  It gets me deeply back in touch with the more clinical aspect of the work I do.  And for that, I am grateful.

While I'm not generally a fan of forced diagnoses, I recognize the importance and need for it.  And for some clients, they feel better with an actual diagnosis.

My hope in writing this blog is to always be open, honest, and transparent about my feelings and struggles as a therapist.  Today was a small example of the thoughts and feelings that go on in my head, when it comes to working with clients.  

Please feel free to comment with your thoughts and opinions, whether you agree with my thoughts or not.  I welcome your ideas.  And please feel free to share my blog with others.

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