Category Archives: Law Ethics & Practice

4 Ethical Loopholes strangle therapists

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Ethical loopholes strangle.
Photo courtesy of Pixabay.com

4 Ethical Loopholes Strangle Therapists – Part 1.

Therapists who violate codes of ethics harm clients; they also may lose their licenses or ruin their carriers. Often these ethical breaches start with thinking that there might be sometimes when it is OK to make an exception to an ethical standard.

Not following ethical guidelines can harm clients. Making exceptions to ethical codes can be fatal flaws.

Therapists are taught codes of ethics in school. We take exams that include questions on laws and ethics or may even need to take a separate law and ethics exam. Every few years most of us have to take a refresher course in law and ethics. Still, people violate these guidelines. Why?

Somewhere down the line, some professionals start looking for loopholes, exceptions to those ethical requirements. When they do this, put their head through that ethical loophole, too often they can get strangled and lose their licenses or lose the trust of their clients.

Four ethical violations seem to create the most problems for clients and therapists. Most of these violations start with the professional think that while this rule is a good one there might be times when someone, not them of course, but another therapist, might do this and that would be OK. Once you have been able to picture a time when there might be an exception to this ethical rule it is likely that you will cross that boundary and try to put your head through that loophole.

Most therapists think immediately about the ethical standard that says no sex with clients. They know that if you think that might EVER be OK then you are at risk to do it. While this is huge for therapists, it may not be the ethical violation that harms the client the most.

Here are the Big 4 ethical violations in their order of harm to the client

1. Not keeping what clients say confidential.

When I get away from other professionals, out in the community this comes up more than I thought it would. Look at the list of top posts on this blog. Month after month people search for information about what is and is not kept confidential. Unfortunately, I also hear too many stories about how a therapist told that client’s story somewhere, someone recognized them from the story and this has hurt them when a family member, friend, or boss found out.

Knowing that the way counseling helps is because of the relationship and that strict confidentiality is fundamental to that confidentiality, how do so many professionals cross that line?

The first stretch through this loophole often happens innocently. Here is a HYPOTHETICAL example.

The therapist is somewhere and is asked about a particular mental health disorder. “Is there any treatment for Trichotillomania?”

“Sure there is, the therapist says. “I saw a client recently with Trichotillomania. She has suffered a trauma and began pulling out her hair uncontrollably, almost unconsciously. I treated her using treatment “X” and she got better.”

So far so good. But the therapist wants to sound great, impress this person, and get more referrals. He or she is thinking maybe I should become the authority on treating trichotillomania in this town. So they go on to tell more.

This was a tough case you know. Her family is very influential in this town. Her father is a prominent politician in this town and he did not want this getting out in his district or it might affect his reelection campaign. That district on the “X” side of town is awful conservative.

Is there a problem now? Sure there is. This is way too much information and has identified that client to anyone who thinks about this for over 5 seconds.

One little story – what harm?

But the next time the story gets more elaborate and before long this clinician is talking about their clients all over. They even decide to warn their church group about that sexual offender that has moved in on the same block as the church. What harm can there be in helping people keep their children safe?

The harm comes first because they have violated that client’s trust and eventually someone will find out and then it turns major. The harm may also include attacks on that client. Sometimes that registered sex offender, the one that the counselor warned people about, what he did was when he was 18 he had sex with his 17-year-old girlfriend and her parents pressed charges. This couple since has gotten married but he could still turn up on a list of sexual offenders.

If this therapist has a private practice and people find out about this they may just stop going to see them. But if the clients are low-income and have to go to a government-funded clinic they may not be allowed to change therapists. They may just stop coming and they will be counted, not as victims of the system but as treatment failures and drop-outs.

You would think a profession like counseling would police itself. Not usually. The complaint in this situation is most effective if it comes from the client. But then the client already afraid because of the harm done to them, that registered sex offender or Muslim may be getting death threats at this point, probably just wants to escape the system.

Other professionals may hesitate to report this. It is their word against the others. Whistleblowers can and do get punished. Also because this happened to a client there may be minimal ways that this can be reported by another counselor without violating this client’s confidentiality again. All of these are ethical and practical concerns.

Oh my! I am past 900 words and have only talked about one of four ways ethical boundary violations hurt clients.

One caution here – Ethical guidelines are just that “Guidelines” not hard and fast rules. So any professional, at any point, is in danger and may have a problem with something. What I am talking about here are the big problems and the professionals who repeatedly break these ethical principles.

In the future, I want to talk about other ethical problems also. My plan is to talk about one of these problems each Friday for the next three weeks. This post was mainly aimed at counselors and would-be counselors, but then I thought others might be interested in the ethical dilemmas we confront.

Here are ethical issues number two, three, and four.

2. Thinking that it is OK to party a little. If you just chip on the weekends how can that hurt clients?

3. Dual Relationships, hiring clients to work for you, getting them to loan you money or loaning them money, especially getting into investments together.

4. Falling in love and getting into sexual relationships with clients. We all want to believe in Snow White and Prince Charming but if a therapist falls in love with a client who came to him with a mental illness, this may turn out more like a sexual predator than a prince.

Let’s look at these three problems over the next three weeks.

Since we are over on words today I will skip the links to other stuff, you know where to find me. Check the categories to the right for more on other mental health and substance abuse issues.

David Joel Miller, LMFT, LPCC

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Will the Counselor, therapist, psychologist keep your secret or tell?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Keeping your secrets?
Photo courtesy of Pixabay.com

Just how confidential is confidentiality.

Just what is confidential and what is not is a major concern to clients in mental health treatment. I have written several posts in the past on this subject but from the number of searches on this subject, we need to talk some more about this. Links to some of the past posts are at the end of this post.

Confidentiality and its cousin privilege, are legal as well as ethical concepts.  Laws can vary greatly from place to place. Check in the jurisdiction you live in and ask the person you are seeing if you have concerns about this.

We spend a lot of time on these issues in graduate school. We are supposed to explain this to clients when we first see them. Beginning counselors tend to spend a lot of time telling new clients more than most clients want to know. After a few years of doing therapy, the amount the client gets told declines and sometimes slips below the minimum the client needs. If your provider has said less than you need to know please ask.

Please remember I am talking about this from a counselor’s point of view, how we try to meet our legal and ethical responsibilities in practice. For the law in this, you should consult a lawyer.

Here are the general rules.

Everything you tell your therapist-counselor is confidential UNLESS it falls into a required or permitted exception.

1. Danger to self is reportable.

If you are eminently suicidal we can break confidentiality to keep the client alive. We are supposed to do this whether we want to or not. In practice, it is a judgment call whether the client has thoughts but does not intend to carry through or if they plan to kill themselves soon. Our response may vary depending on the circumstances.

2. Danger to others gets reported.

If you say you intend to kill someone in the future this gets reported. Past crimes are generally not reportable unless they fall under one of the other exceptions. Throwing a book at your sister is not a danger to others.

3. Child abuse, abuse of an elderly or disabled person needs reporting.

Generally, all abuse of a child gets reported if the provider has a reason to suspect the child is being abused. The counselor is not responsible for investigating, only to report to authorities. Someone who murdered a child would have committed child abuse and this past crime could be a mandated report in some places.

4. If the counselor needs to consult with another professional.

In this case, they tell the minimum they need to get the answers they need. They might talk to another professional about your treatment, to a lawyer about what is reportable, or to a billing person. They can “use” the information you give them to help in your treatment and their getting paid for providing it, but they are not supposed to “disclose” that information to people who do not need to know. Counselors sometimes call their lawyers to find out what they need to keep confidential and what they need to disclose.

5. If you are Gravely Disabled they need to report to get you help.

If the client can’t feed themselves or use clothing and shelter the counselor needs to call someone and get this person help.

6. You sue your counselor and they can talk about treating you.

If you sue your counselor for doing a bad job they get to introduce your records and prove what you said and why they did what they did.

7. If you introduce your mental status into a court proceeding they will be required to tell things.

Once you use your mental illness as a defense in court for something you are charged with all your mental health records may come out.

8. You are not the client and are not paying for the counseling.

If you are sent for a court-ordered examination, a child protective service interview or other assessment paid for by someone else you will probably be asked to sign a release of information so that the person paying for the services can see what happened.

No release and there will be no treatment. Once you sign that release the person who is paying or who ordered the assessment and or treatment gets reports. You can revoke this sometimes, but not all the time, and what has been disclosed cannot, of course, be taken back and remade confidential.

9. You are a collateral person in a session.

If you go with your partner or child and they are the person being treated you may not be getting any confidentiality on what you say. You should ask about this before you stay things and then want them kept secret.

10. A court subpoenas your records.

This gets problematic. The counselor or therapist will try to keep some things confidential by asserting privilege but that is up to the lawyers and the judge. If this is a worry to you talk to your lawyer before you see the counselor and see if there is a chance this will come up in court.

One last thought. There are some clients who come for therapy and talk extensively about how guilty they feel about past crimes and how they want to change. They don’t usually give all the details of the crimes. There are others who seem to want to brag about what great criminals they are and they don’t want to change. The ones who don’t want to change frequently say things that end up needing to be disclosed.

Facing the things you have done wrong and trying to change is a huge part of recovery.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Can an LPCC practice privately? Reader Question # 2

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

So now LPCC’s are licensed – where can they work?

In California, an LPCC can practice privately if – and only if, they are licensed here in California. So far the only people who meet this requirement are those who already had another license (LMFT or LCSW) here in California and who took the Gap exam to qualify for the LPCC license also. People who were licensed as a Professional Counselor in other states and moved here are beginning to qualify to take exams and become California licensed LPCC’s.

LPCC’s have a special role in working in career counseling, mediation, and a few other areas that are somewhat different from other mental health professions. LPCC’s should not treat children, families, or couples unless they have had additional training in those areas similar to the training LMFT’s receive.

Interns of any license (MFT interns, ASW, and PCC interns) are not allowed to have their own practice and must work under another licensed person. In a for-profit practice, the intern can only work for a limited period (6 years) while gathering supervised hours and testing. Interns and associates who work in governmental settings or other “exempt” settings may be able to work longer than the 6 year period their first intern number is good for.

Because of quality concerns, I expect most employers to limit the time interns who work for them have to get licensed and still work seeing clients.

Some people are attempting to get around this licensing requirement by calling themselves Life Coaches, a profession that to the best of my knowledge is currently not licensed or regulated. If the client’s issue relates to anything that may be caused by a mental, emotional, or behavioral disorder then the client should be seen by a licensed mental health professional. Coaches should restrict their practice to clients who do not have a mental illness but want help in accomplishing more in life.

The more promotional material I read and view online from coaches the more nervous I am that they may be stepping outside their scope of competency as well as their scope of practice.

The laws may vary in other jurisdictions but the legal and ethical principles to stay within your scope of practice and scope of competency should be the same everywhere.

Thanks for that question.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Must psychologist report patient planning a crime

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

More about when the therapist breaks confidentiality Reader Question #1

Please with crime scene tape

Do therapists have to report a crime?
Picture courtesy of pixabay

Most of the time therapists, counselors, and psychologists do not report past crimes. If the crime may occur in the future, then we have a problem. How does the treating professional balance the duty to protect the public with the need to maintain a trusting relationship with the client?

In past posts, I talked about some of the standard exceptions to confidentiality. Things like child abuse or an intent to harm themselves or others. If the client tells me about a plan, to harm or otherwise abuse a child, or kill their partner and them themselves, I feel both ethically and legally bound to intervene and try to stop this. How I go about intervening may be a matter of my best “clinical judgment.”

But this planning a crime issue, that is tricky.

One thing every professional should do is have a place they can go to for legal and ethical advice. This is one of the reasons I am a member of both CALPCC (California Associations for Licensed Professional Clinical Counselors) and CAMFT (California Association of Marriage and Family Therapists.) Professional associations often offer services to answer or refer you to answers for ethical and legal questions. CAMFT has lawyers on staff who can answer these kinds of questions if you are a member.

So a counselor who is presented with this situation may well consult with a legal or ethical adviser. While doing this consultation they would use the minimum amount of information needed to get an answer. They should not give the client’s name or identifying info but only the nature of the crime the client says they might commit and then ask if they legally or ethically need to make any kind of report.

I mentioned also that it matters who is paying this counselor. If you go to a government psychologist and are planning on cheating disability by lying about your symptoms, that professional is working for the government and will report your effort as fraud. The point of the interview is to see if you are disabled. Even if your treating clinician does not disclose something you said they will not lie by leaving out things that would affect the decision someone else is making.

So what kinds of crimes can I think of that might need to be reported?

If my client was thinking of burning down a building or planting a bomb, I might need to report that and warn people near that building because of the high risk that someone would be hurt. If they were planning to set a fire and they shoot first responders, I feel that this is absolutely reportable.

We do encourage clients to talk with us about anything and everything so we can help them and I would want to try to help my client find other ways to accomplish their goals without committing a crime.

Generally, financial type crimes, writing bad checks, or cheating on your taxes, we don’t have to report clients for that. But we do want to work with them on why that lifestyle may lead to worse things. What a counselor should not do is help the client plan ways to get away with a crime.

One last exception to confidentiality no one ever seems to talk about is if the client is a terrorist. If they are plotting a terrorist attack, even if no person is likely to be harmed, the treating professional may be required to divulge that information. Homeland security can require treating professionals to disclose certain things.

But honestly, this is not a big problem for counselors; suicide bombers probably do not see therapists. Around here we aren’t likely to hear about any Homeland security related issues. There are not many terrorist attacks on cattle feedlots or vegetable growers.

Yes, I live in California, but remember that a large part of this state is a long way from the ocean.

Not sure that really answered the question, but I know that the worry about how much to tell and how much you need to hold back from your counselor is on a lot of client’s minds. If you can’t trust your therapist it is hard for them to be able to help you.

When in doubt ask the person you are seeing and judge by their answer if they will try to help you while staying inside the law and ethical guidelines.

This has been a general discussion of legal and ethical issues involved in a client and counselor discussing the client’s plan to commit a crime. Remember I am a counselor, not a lawyer and legal issues vary from jurisdiction to jurisdiction. For your specific situation, you may need to talk to a lawyer.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

How does my therapist know that? Isn’t counseling confidential?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Is counseling confidential?
Picture courtesy of pixabay.

Did my last therapist tell?

This comes up a lot when people move from provider to provider. It especially happens when you see multiple people in the same agency. No not everything you told your old therapist will be kept secret from your new one. WHY?

Laws about confidentiality make a distinction between “Use” and “Disclosure” of information. If you are in the hospital anyone who is treating you needs to be able to look at your record and see what medications you are on, what procedures you have had, and what allergies you may have. Anyone who treats you in the future at that agency probably has the right to look at your old record and see what was done to you. The same applies to psychotherapy.

Everyone at the hospital does not get to look at anyone’s medical record just because they want to see it. The only reason to access a medical record should be for the purpose of treatment. People have gotten fired for looking up someone’s medical record just because they were curious. Even looking in medical records to see if a famous or infamous person was treated at your hospital can get you fired. But if you are treating a client you may need to know what is in their record.

Psychotherapists do and can share records and that is considered “use” not “disclosure.” Laws about confidentiality primarily relate to disclosure. Some of this has to do with law, for that see a lawyer. As a therapist though, I find this is an important issue to many of my clients and they need to understand how our system works.

It is considered good practice to separate psychotherapy notes from your general medical file. Everyone who treats you in the emergency room for an accident does not need to know about your marital problems.

We also don’t need a list of the names you or your spouse call each other. What the counselor wants to know is that you two are having conflicts and that you resort to name-calling with each other rather than problem-solving. One or two examples will suffice here. Long transcripts of the argument might be interesting in a movie script but they don’t need to be in psychotherapy notes.

Clients sometimes move from therapist to therapist. Sometimes clients want a new counselor, some therapists are known to “fire” clients for a variety of reasons. Ethically we should suggest a change of provider if we feel that we are not able to help a client. If your counselor retires, you may be assigned a new one.

When the client changes therapist, we do not, as a rule, start a new file. Would you want to go through all those tests and lab work every time you saw a different doctor? Same with taking a life history. It should be in your chart. The new provider should review your chart so they should have some knowledge of what your last therapist was treating you for and why.

Charts are needed to provide continuity of care as well as other reasons. Clients have told me they resent that the new therapist knows things they had not told them. They probably read this in the chart though they may have been briefed on the case by the last provider also. If the file moved to a new agency there probably was a release of information but at the same agency, the old paperwork still applies.

Personally, I like to meet the client first and form my own opinion about them, then review the chart. The risk is that the client will have to tell me something they just told the other counselor last week. The benefit is that in telling me again they may say something they did not say last time or I may ask a different question. A fresh set of eyes can sometimes see something new.

More than once after doing a new assessment I looked at the file and can see why the last counselor came up with the diagnosis they did, but having new facts I don’t necessarily agree with that opinion.

So yes, the new therapist may know something you did not tell them. That they were filled in by your previous provider is not a violation of confidentiality. Did you really want to have to retell your whole life history to a new person before getting down to the work of solving life’s problems?

The bigger question is why you would want to hide things from the therapist you are seeing now?  They will have trouble helping you if you don’t tell them what the situation really is.

The most important person for you to trust and get honest with is you. Some clients hide things from their counselor because they don’t want to face the fact that they have a particular problem.

The results of counseling are mostly about the relationship. We try to spend time upfront getting to know clients and building trust. Some clients have more trust issues than others. If you are not sure you trust your therapist, ask them questions. The names of their kids and their spouse are not important but their views on how to raise a child or have a good relationship might matter to you.

You should be able to rely on your provider to maintaining your confidentiality and not disclosing your information to someone who has no reason to know. Don’t expect one doctor or therapist to try to hide your symptoms from another professional who is treating you.

The bottom line? If you want help in recovering from your issues, whatever they are, you need to get honest with yourself and your counselor or find a provider you feel you can trust.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

CALPCC, California and the future.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

More about the new field of Professional Clinical Counseling.

Some of you have read my posts on LPCC’s and the establishment of Professional Clinical Counseling here in California. Those who know me personally, in the before the blog days, have probably heard me talk about my belief that there is a difference between MFT’s, LCSW’s, and the new LPCC profession.

I have written some posts about LPCC’s and my experience with taking the GAP exam. I became licensed as an MFT (LMFT) because at the time California did not offer the LPCC license as an option. When the opportunity arose to take the GAP exam and become licensed as an LPCC I took it. Because in private practice I do see children, couples, and families I will continue to maintain both.

Why was California the last state to license LPCC’s?

Most other states license Professional Counselors, Clinical Counselors, or some similar title.

Not all states licensed marriage and family therapists. (Update: I am told they now all do.) In fact, the California Association of MFT’s (CAMFT) has more members than the national association (AAMFT.)  States that recognized LPCC’s first were slow to recognize MFT’s and vice versa.

It has taken a while to recognize the importance of mental health as an integral part of providing health care. The various specialties within the area of mental health, substance abuse, and co-occurring disorders continue to evolve and differentiate.

It took a long time to establish that there were other mental health specialties beyond Social Workers and psychiatrists. Some states elected to license Professional Clinical Counselors first and other states recognized Marriage and Family Therapists first. Eventually, I believe, both professions will be recognized everywhere as important additions to the mental health field.

My past posts on LPCC’s were written from my perspective as I took the step to take the GAP exam and complete both licenses. See:

Therapist, Counselor, or Social Worker?

Licensed Professional Clinical Counselor (LPCC) Update

Licensed Professional Clinical Counselor (LPCC) in California

LPCC Exam is behind me!

LPC or LPCC?   

Recently I have been talking with CALPCC about ways in which I could become more involved with CALPCC. More about that in a future blog post.

If you are interested in CALPCC or the profession of Licensed Professional Clinical Counselors take a look at CALPCC’s website.    http://calpcc.org/

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What if a client tells you they had sex with their last psychotherapist?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Couple

Sex?
Photo courtesy of pixabay.

Sex is not the cure – Morning Question #19.

Ethically this is never considered acceptable. If the client was a child we would report this as child sexual abuse. If they were adults they need to report this to the licensing board. In California, we have a nifty little book called “Professional Therapy Never Includes Sex.” We are supposed to keep this book handy and give it to anyone who tells us they had sex with a previous therapist. What they do about the situation is up to them.

One reason sex with patients is not considered acceptable is the trust clients put in their therapist to help them sort out emotions. Getting into a relationship other than the therapeutic one is likely to result in the therapist taking advantage of the client.

What to do about this situation generally is up to the client, not the new therapist. Laws could, of course, be different where you live but second relationships with clients are considered unethical most everywhere.

More on this is here and info on what counseling should be is at Counseling as a novel relationship.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Does abuse of seniors and the disabled get reported?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Older people

Elderly couple.
Photo courtesy of Pixabay.com

Reporting abuse of a senior citizen or a disabled person.

Most people are well aware that child abuse and neglect get reported, but reporting abuse of other vulnerable people gets forgotten. This is a legal and an ethical question. For legal advice please consult with a lawyer or your local statue. There are lots of ifs, and’s and exceptions here. I will keep this simple.

From a California LPCC and LMFT’s point of view here are some things to think about. Every two years when we renew our licenses we have to take a refresher course on Law and Ethics, so we stay up to date and don’t forget things we are required to do. Sometimes we need to check out the fine points of the law also.

There are two types of report categories, mandatory and permitted and then there are categories of victims of abuse, children, seniors, and the disabled.

Mandated Reports.

In most places, there are groups of people called “mandated reporters.” These are people who work with a vulnerable group of people, may learn about abuse or neglect, and are required by law and ethical codes to report abuse and neglect.

In California, mental health professionals (LMFT’s LPCC’s, LCSW’s, etc.) are mandated reporters. In short, if we know or should know about some abuse or neglect, we have no choice, we have to make the call and report this.

This does not mean that we go around the neighborhood looking over fences for a crime. Mental health professionals are not the police. We don’t report crimes and as a rule, are required to keep anything the client says confidential EXCEPT that abuse and neglect stuff.

But if while doing therapy, we are told about abuse or neglect we can’t let that go. We have to make this report.

There are some iffy areas here that can vary from place to place and are open to interpretations. Cruelty to animals and domestic violence are deplorable but most of the time this does not trigger mandatory reports. Some agencies would like to expand the number of things we have to report but if the list swells beyond what is absolutely needed it keeps people from coming to their therapist and telling them things that they need help with.

Because we have to make this report and others, we are supposed to inform our clients of the things that we must report. This along with fees and other stuff like that is called “informed consent.” You can’t very well consent if you have not been informed, can you?  Remember in most counseling settings, the abuse gets reported, like it or not and neither you nor the counselor has a choice in this.

Permitted reports.

Any member of the public can report abuse at any time. Permitted reports can be anonymous. The reporting person is supposed to be kept confidential but sometimes people do things they are not supposed to do like tell the person involved who reported them.

My understanding of this is – if I am a mandated reporter, I can’t make an anonymous report. Some of my colleagues have argued with me about this. But the first thing they ask me on the phone is “are you a mandated reporter?” Once I say yes I can’t very well try to make an anonymous report. Besides if I am required to do this I want a record that I did it. It took a lot of work to get these licenses and I want to keep them.

One difference between mandated and permitted reports may be that mandated reporters have lots of protection if they make a report, whether it turns out to be true or not. We don’t investigate people. We report it once and unless we learn more down the road we are done.

People who make Permitted reports get in a lot of trouble for making too many unsubstantiated reports. In divorce cases, there is this temptation to think your ex should never be allowed to see these kids again. He cheated on you, right? Cheating on a spouse is most likely not abuse of the child. If you make daily reports on your ex, pretty soon the authorities stop listening to you and they may even come after you for false reporting.

So the people who might get abused or neglected are Children, the elderly (seniors), and the disabled.

Child abuse and neglect are the most common by far.

Remember abuse is really bad stuff, not just stuff we don’t like such as strict parents. Lots of parents want their 17-year-old daughter’s 18-year-old boyfriend arrested for them having sex. That may be statutory rape, a crime, but it is not generally child sexual abuse. Counselors don’t report crimes they report abuse or neglect, which just happens to be a crime also.

If that 18-year-old boy is having sex with your eleven-year-old daughter that is pretty much child sexual abuse everywhere and that will get reported to the proper authorities in a heartbeat.

Abuse or neglect of Senior citizens and the disabled are also reported.

It is probably a mandated report if you are a mandated reporter. For sure it is here in California. These are classes of people who because of their age or disability cannot fully take care of and or protect themselves. Society steps in to take care of them.

Besides the types of abuse that apply to children, another type of abuse is common when it comes to the elderly and the disabled, financial abuse.

Now some seniors choose to have relatives live with them or give those relatives gifts. But if that other person does not care for the elderly person and bullies them or cheats them out of the money then it may be a crime. It may also be elder or disabled person abuse.

One warning here

Some people come to therapists and tell us tales of people being abused but they don’t want to get involved or make the report. All that second-hand information may not meet the criteria for a “mandated report.”  Calling a therapist to tell them about your suspicions will not help the person. The therapist can’t go out and investigate. If you think someone is being abused, you should be the one making the report.

Hope this helped to get you thinking about the problem of abuse and neglect in our society and the role of the mandated reporter and the possibility that abuse and neglect could include senior citizens and the disabled.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel