In Part 1, which was an excerpt from my Basics of California Law text, I discussed the subtle ways that even well-meaning therapists can subvert a license exam. Here in Part 2, available only online, I’ll get more specific about what kinds of things I think can be safely shared and what probably can’t.
With so many therapists and clients owning iPhones, some therapists have started experimenting with doing sessions via Apple’s FaceTime videoconferencing. While Apple does not provide a Business Associate Agreement (typically required under HIPAA) for use of FaceTime, there is an interesting legal argument that suggests FaceTime may still be safe for therapists to use.
It is essential to the fairness and validity of any testing process that those who take the test are who they say they are, do not attempt to cheat on the test, and do not reveal any information about test content to those who have not yet taken the exam. This is certainly true with license exams, which are considered high-stakes tests because failing can directly impact one’s professional standing and job opportunities.
Violating exam security or subverting a license exam, one of the forms of unprofessional conduct that can lead to discipline from the Board of Behavioral Sciences, occurs most commonly when someone who has just taken their exam shares its content with others who have not yet taken the exam. “Subverting,” as it is used here, means impacting the integrity of the exam; while sharing content is perhaps the most common way this happens, it certainly is not the only way it could occur.
At the risk of being exposed for the nerd I am, I’ve been closely following the TV show The Flash. It tells the story of the superhero dubbed “The fastest man alive.” When I sat down to watch a recent episode, I read the description before starting. That description noted that the main character was going to be attending a therapy session with his wife. I immediately became skeptical. Most movie and TV therapists act unprofessionally, unethically, or some combination of the two (for example, the therapist in 13 Reasons Why).
I didn’t know whether to continue watching, for fear that a bad therapist would ruin the entire show. I recognize the irrationality in that thought, but I’m proud of my education and my profession. I have a hard time supporting those who portray it poorly.
I decided to stick it out and give the show a chance, and I am glad that I did.
As mental health clinicians, we all know the importance of setting and maintaining boundaries with clients. We have several posts on this blog about setting boundaries online, specifically in regards to social media use (1 2 3). One boundary that we have not discussed is how to manage situations when you see a client outside of the regular therapy setting.
Therapists generally agree that we do not to approach clients outside of therapy, out of respect for the client’s confidentiality. If someone else knows that you are a therapist, they may make the connection that the person you are interacting with is a client. If a client approaches the therapist first, however, engaging is often considered appropriate. Even so, many therapists agree that it is difficult to maintain professional boundaries while also engaging clients socially.
Legal and technological changes are further complicating the potentially uncomfortable situations where we might encounter clients outside of the office. More specifically, we may see clients in settings that were not previously socially acceptable or accessible. Therapists today are at risk of seeing clients on dating apps, at meet-up groups, and at marijuana dispensaries. The potential for seeing clients in social situations has always been present, but there is added risk that those interactions will reveal private details about your personal life.
Casey Meinster is the Director of Evidence Based Practices at Hathaway-Sycamores Child and Family Services, a major mental health services provider in Los Angeles. In that role, she wrangles a lot of information. But one piece of information I learned from her changed how I think about the importance of measurement in psychotherapy.
Hathway-Sycamores serves thousands of clients a year through more than a dozen programs. They fund those programs through a variety of sources, including government contracts, grants, and other sources. And it is now the case that every single program they run now has to produce outcome data on its clients. Their payors demand it.
California suffers from a severe and worsening mental health workforce shortage. In fact, much of the US is in the same boat. There simply aren’t enough qualified mental health professionals to meet our country’s needs.
At the same time, therapists in private practice often complain about their local markets being saturated. There are so many therapists in some places, it seems, that it’s hard to get a career off the ground.
As it turns out, there’s truth to both of these perspectives.
From students and colleagues alike, I often hear statements to the effect of “There are a lot of bad therapists out there.” As I understand it, “bad” in this context has a variety of meanings, ranging from ineffective to unethical. At either end of that spectrum, though, the next question is usually the same: How do they stay licensed?
In January we launched our #PostThePay campaign. Every California job applicant has a legal right to know the pay of the position they’re applying for. When employers post pay information in job announcements, they save themselves time and promote fair wages in the mental health field. But how can you help ensure fair wages if you’re already employed? What if you know the pay of a position, but aren’t quite satisfied about it? Here are some ways you can advocate for better pay in therapy and counseling jobs.
If you haven’t noticed, telehealth is an ongoing theme around here. Last year, we posted on what we know and don’t know about online therapy, and four reasons to move your practice online. I also proudly chaired the workgroup that developed AAMFT’s Best Practices in the Online Practice of Couple and Family Therapy, which is available for free here.
We know a lot of therapists are still worried about using technology in their practices, and we have good news — regulations are getting clearer, and so is the technology itself. In short, it’s easier and safer than ever to move part or all of your therapy practice online.