Look, I’m not here to defend the BBS (California’s Board of Behavioral Sciences) or any other licensing board. They’re not your friend. They require deeply flawed exams that even they know don’t work. Their disciplinary guidelines, especially around substance use issues, are unreasonably punitive. They are notoriously unresponsive. There are a lot of problems there. But it’s also true that most complaints about the BBS are based on flat-out falsehoods.
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.
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.
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?
Many of our readers reacted with surprise to Monday’s post (“Facebook connects your clients, even if you don’t use Facebook”). It certainly reinforces the idea that if you are not actively and regularly working to protect the confidentiality of your clients on social media, you may not be doing enough.
In testimony to Congress the week before last, Facebook CEO Mark Zuckerberg made a point of emphasizing that if you’re a Facebook user, you own your information. This is meant to reassure users, but it is more than a little misleading. “Your information” is what you personally have uploaded to Facebook. You do not own what other people have uploaded about you. That’s what has privacy advocates so concerned. It’s also why even therapists who don’t use Facebook should be worried about the client confidentiality risks that the company poses.
Therapists and counselors are increasingly required to formally gather outcome data on their work. This is good: The more data that we have on our work, the more intentional and effective our clinical decisions can become. Regularly collecting and attending to outcome data, therefore, suggests constant movement towards improvement.
Many therapists struggle, however, with questions about what data to gather, and how to best gather it. Even among those who philosophically agree that regularly collecting outcome data helps to more meaningfully direct therapy, they often don’t do it.
Thankfully, there are a number of easy ways for therapists to collect outcome data. Many come at no cost. The following are just three of the many different tools/assessments therapists can use to collect and interpret outcome data.
From the time you were in graduate school, your instructors and supervisors have likely emphasized the importance of self-care. Burnout is a real risk in the world of counseling and psychotherapy, and you have to be able to take care of yourself in order to avoid it.
These messages come from a good place. But they ignore reality for many therapists, especially those early in their careers. And those messages often come with dangerous assumptions and a dark undercurrent: If you’re having a hard time, it’s your own fault.