Topic 7: Ethical Considerations and Non-Therapy Duties {by 3/5}

Based on the readings due this week consider the following two discussion points: (1) Based on Table 2.2, what best ethical practice do you think is the most challenging to uphold (either for yourself or other professionals)? Explain. (2) What required duties beyond therapy do you find the most frustrating and/or least enjoyable?  Your original post should be posted by the beginning of class 3/5.  Post your two replies no later than 3/7.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

29 Comments (+add yours?)

  1. Amanda Russo-Folco
    Mar 01, 2020 @ 12:54:17

    Based on Table 2.2, the best ethical practice that I think is most challenging to uphold personally and for other professionals is “thorough documentation is best”. I think documentation is challenging in general because it is difficult to try and remember everything the client says and have the information said in their words. Also, it is difficult to pinpoint the most relevant information in a session and information to disregard. Looking over the table, I never considered out-of-office contact to be something that is important to document or even supervision feedback after a significant counseling event. However, that is something I will consider doing whenever it does happen now that I am aware that is something to document. I think in this field, documentation is super important, and it can also be something that is challenging for others because they might not document things that they are supposed to be documenting for instance, attempts to follow-up with clients who no-show. That is something that is minor but still important to make note of. I find that documentation goes a long way and it helps to remind the clinician of what has been going on with their clients and to also cover themselves in case something ever comes back around to the clinician.

    The required duties beyond therapy that I find to be most frustrating and/or least enjoyable is progress notes and filling out the comprehensive assessment. It is frustrating to me doing progress notes and least enjoyable to do the comprehensive assessment. In regard to progress notes, it is difficult for me to pick out the most relevant information in session and if there are sessions that the client is just strictly “venting” and not doing any therapeutic interventions in that particular session, it is difficult to do a progress note for these clients. However, I feel that the more progress notes I do, the easier it will be to complete them. I find the comprehensive assessment least enjoyable because this is something that takes a long time to do since its part of the intake, however, it is very important in terms of information gathering so it is understandable why these assessments take a few sessions to complete.

    Reply

    • Jayson
      Mar 03, 2020 @ 20:54:12

      Hi Amanda,
      I agree with your statement of “In regard to progress notes, it is difficult for me to pick out the most relevant information in session”. I do have situations when I just do not know what information should be included in the progress note. Sure, we can always write down everything that happened in session, but time is limited and we all have to do other things so it is essential to pick the most relevant information. Whenever I do a note and once I submit it, I always tell myself, “dang, i should have wrote that in the note too”. I usually tend to write down anything that stands out in session such as the client being highly distressed over a certain topic.

      Reply

  2. Alyce Almeida
    Mar 01, 2020 @ 15:37:37

    After reading and seeing table 2.2 I think the most challenging thing to uphold for most professionals from what I noticed and myself personally is “Caution with Social Media.” With today’s society, social media unfortunately is quite important for many (too important) and a huge form of communication. I’ve seen numerous situations of various patients reporting that they’re friends with their outpatient therapists on multiple social media platforms. I do not have any patients as friends and never intend to do so because it kind of freaks me out in a way since they’ll be seeing me on a more personal level that I would not want them to see. I used to work with teens and children and they would try to friend me on different platforms all the time, and I would constantly have to decline the requests and explain to them again in person that it was inappropriate. It concerns me that many therapists are quite relaxed about this, because I do think it could impact the therapeutic relationship and potentially blur the lines for clients with boundaries and what exactly is appropriate or not. Giving the wrong idea is something I want to avoid entirely since I have been providing therapy for patients who are now my age. Since I’ve had numerous encounters with patients attempting to friend me, I’ve been more conscious about what I post and what is easily accessible for people to find about me. I think it’s very easy to uphold this expectation when you think of it as a simple responsibility, but I think for some people they might not realize what they post or share may effect their clients or relationship as whole.

    With my interning experience the paperwork aspect has been rough in the sense that I have a lot to complete in quite a short amount of time in comparison with outpatient therapy. Just that alone has been frustrating since I have half the time to complete the intake, then actually document that intake, along with the treatment plan and formulation. I would say the overall process and timing is most frustrating for me as I’m crunched for time and am quite the perfectionist so I have high expectations for my documentation to not only be accurate but well written. The least enjoyable for me would honestly be the intake paperwork. I’m alright with the progress notes as they’re shorter and straight to the point, but with the intake it’s quite extensive and tedious. I enjoy physically doing the intake since I get to know my patient and really conceptualize whats going on, but having to then report all of that information is the lengthy part.

    Along with the paperwork, the other aspect of duties beyond therapy that really stuck out to me was working with your colleagues. I’ve mentioned it in class but I had quite the rough start with my colleagues at internship, and it 100% impacts you in multiple ways. It impacts how you conduct yourself while doing therapy, how you communicate in general, and really how you feel about your role and work environment as a whole. I’ve been lucky to have really great colleagues who are supportive, filled with knowledge, and just great people to work alongside and get feedback from throughout my various jobs and past experience. But there of course have been various personalities, and situations that have been quite negative and really alter your perspective and way you conduct yourself overall. I find it extremely frustrating when I get essentially judged on my personality rather quickly without really being given a chance to really show who I am. I also get really frustrated with work gossip, and the “he said she said” that many people get involved with – especially if it’s a misrepresentation of myself or something I said or did. I think the least enjoyable aspect of working with colleagues is the underlying fear you may have when working with them, as people of seniority may have more of a say than you may and potentially take advantage of that. I’m hopeful I’ll have more positive experiences than negatives in the future in regards to working with colleagues because it can real make or break your experience overall.

    Reply

    • Amanda Russo-Folco
      Mar 03, 2020 @ 13:48:32

      Alyce,

      Thank you for sharing your own personal experiences in regard to this topic. I enjoyed reading your discussion post. I totally agree with you that it is inappropriate to have clients as your friend on social media and everything that you said makes total sense. I feel the same way that it could ruin the therapeutic relationship with clients and it does not set appropriate boundaries either. If they send friend requests, it is important to like you said “decline requests” because it is important for us to be seen as professionals and not someone that is one of their friends. Regarding your experience with this, it must have been extremely frustrating and annoying to constantly have to explain yourself about declining their requests.

      Reply

    • Marissa Martufi
      Mar 03, 2020 @ 17:04:20

      Alyce,
      I totally agree with you in regards to social media. Working with youth and adolescents is a challenge with social media because they are ALL over social media and probably know how to use it and find things through it, better than we do! It’s so important to be conscious about what we post on social media and consider how the things we most may impact our role or identity as a professional, and their clients. I think many times people don’t think of it as a big deal and become very laid-back about it, but the reality is that social media can be accessed by anyone so it’s so important to really be aware of that and be mindful of what you do post and share.

      Reply

  3. Mikala Korbey
    Mar 02, 2020 @ 08:56:03

    1) After reading this table, two things really stand out to me as things that seem noteworthy. The first is the Thorough Documentation. In a school setting limited documentation specifically regarding relevant history and consultation with others. Schools are only required to document for IEP meetings and progress reports, however I have not seen any sort of official documentation system regarding meeting with students, what is discussed or treatment planning. From what I have gathered, in my setting it is up to the counselor if they want to track information regarding the student and it is not input into a system. I also have seen limited consultation with other counselors among the special ed and general ed counselors and I am not quite sure why. That is something I would do differently if I was in this position. Another thing that is a big issue I see in my school placement is self-disclosure. In schools, it seems like boundaries are not as rigid as they probably are in other more clinical settings, and it is something I am not comfortable with either. People are very quick to share information about their personal lives or families with students, whereas I am very limited in the information I give to students about myself. I wonder if the students notice or think a certain way about me because I am not as eager to share personal information.

    2) It seems like paperwork is something that is a common thing a lot of people struggle with and do not enjoy doing because it is easy to let it get piled up. I would need to develop a good plan to stay on top of paperwork so that I do not feel overwhelmed. I also think that progress notes are something that could easily get thrown to the wayside if you do not keep up with them. I think in a perfect world I would have to do them right away so that I do not forget about them, which I know is not usually doable, especially if you have multiple clients back to back. Although these things are easy to lose track of, it is important to stay on top of them.

    Reply

    • Amanda Russo-Folco
      Mar 03, 2020 @ 13:55:44

      Mikala,

      Now that you have mentioned self-disclosure in a school setting, I have noticed that a lot more now in my internship placement, when I am interning at the school once a week. Being in a school setting is completely different than an outpatient setting and a lot of things are different, such as the two topics you mentioned documentation and self-disclosure. Thank you for sharing your own personal experience because there a lot of similarities I see as well with my school placement. I do not self-disclose any information either with students because I feel like if I do, I am crossing boundaries and I don’t like being in that position like you mentioned as well.

      Reply

    • Marissa Martufi
      Mar 03, 2020 @ 17:11:12

      Mikala, I never realized that about the school setting. Thorough documentation is a critical component to the work we do as professionals and I agree that this is something that should be done differently in that position. Also, having worked in a school, I agree that self-disclosure and boundaries are less rigid than in other settings, which I find interesting. When I worked in the school, I was very cautious and aware of what I shared/didn’t share. I also remember that many teachers/staff including myself only had students call us by our first name (Ms. Marissa) instead of our last name, just for confidentiality and to avoid students potentially finding us on social media or find information about us and our personal lives. In the school setting especially, I don’t really find it beneficial to self-disclose or share information about your personal life. There are many other ways to build and establish rapport with students without crossing or setting unclear boundaries.

      Reply

  4. Marissa Martufi
    Mar 03, 2020 @ 16:59:51

    After reading and reviewing table 2.2, I think the most challenging ethical practice to uphold for most professionals including myself would be caution with social media. I think this is a huge one because social media is such a pertinent factor in today’s society and has such a heavy presence. Many people use social media as a way of marketing themselves and/or their brand or business, whereas others use social media as a platform to connect and communicate with others and share their daily life and experiences. However, it is also something that easily be mistaken or misused and can cause for boundaries being crossed even with harmless intentions. As we have mentioned in class before, social media can be a huge conflict as a professional, and especially with client. It’s so important to be aware and conscious of this as a professional because social media is so readily available and accessible to individuals, it wouldn’t be uncommon for a client to send a friend request or attempt to find you on social media. I would never ‘friend’ or accept a ‘friend request’ or follow a client on any form of social media. (Personally, I struggle to understand why any professional would!) I think that accepting these requests or allow clients to friend you on social media leads to confusion and blurred boundaries/lines when it comes to your relationship. You are their therapist, not their friend and I think social media interaction becomes unprofessional and really creates more of a friendship than a professional and ethical relationship. This may also cause damage to your therapeutic rapport and relationship because clients may find or see a different side of you on social media. I think that social media is something that professionals, including myself, should be cautious of and the way we use social media. I have seen some therapists or professionals utilize social media as a way of marketing themselves and their expertise by sharing positive quotes, messages, or even ‘tips for relaxation’ etc. and I think that can be really beneficial to some people, however it is important even with that to be mindful of what you are putting out there with clients in mind. It is especially difficult today because social media is so relevant and just apart of most people’s daily lives. But as I said, at the end of the day- you are a professional and you need to be aware of what is accessible to others via social media.

    Required duties beyond therapy that I find to be least enjoyable or most frustrating would be time management and documentation. Interning at Butler Hospital was a fast paced environment and required therapists to be extremely mindful of their time and were really encouraged to work at a fast pace. This was VERY overwhelming as an intern because there were so many responsibilities to cover particularly with a new patient and often, very little time to complete the required paperwork and documentation. Something I struggle with is being a perfectionist and often paying very close attention to detail. This was a struggle for me in that environment because I tend to be a very thorough and detailed documenter and there wasn’t always time for that. I quickly learned that although it is frustrating, it is so important to document specific and important information while being direct and to the point. I tend to over-include information, sometimes taking up too much time and causing me more stress because I may not have been sticking to my time-management schedule as I should.

    Reply

    • Jayson
      Mar 03, 2020 @ 20:48:47

      I do agree with your comment “It’s so important to be aware and conscious of this as a professional because social media is so readily available and accessible to individuals”. Essentially everyone uses social media and if a client wants to search you their therapist, it is definitely possible. As professionals, using social media needs to be very carefully dealt with because boundaries can be crossed and clients may find information about you. For instance, there are some social media that has your phone number on public!

      Reply

    • Alyce Almeida
      Mar 07, 2020 @ 10:19:29

      Marissa,

      Your points about social media are spot on. Social media could definitely be used inappropriately and can cause some concerns if so. Your point on professionals accepting friend requests and it blurring the line is so accurate. It can really impact the therapeutic relationship and cross ethical boundaries. I loved your point on therapist using their platform as a chance to share their expertise and I too think that yes that’s great – we should also be cautious around that too!

      Reply

  5. Jayson
    Mar 03, 2020 @ 20:42:36

    1. For myself, I tend to struggle with the inappropriate self-disclosure. Having a therapy conversation during session is a whole completely new way to talk. For instance, regular conversations that we usually have in everyday life usually consist of one person sharing something and the other person sharing something similar to what the person just said. However, in therapy, this way of talking is not done because the client should be disclosing and not the therapist. In other words, it can be seen as a one-sided conversation of just the client sharing. I have experienced a few times where I catch myself disclosing personal information to my client. For instance, today during session, my client is showing me a video of her dancing at a family Spanish party and I automatically began talking about how her party resembles how my typical Spanish party is like at home. At the end of my disclosure, I ask myself, “Why did I say that?” It is still a little weird for me to not share my personal information when someone else is sharing their personal information. I have had clients tell me before, “You know Jayson, this is strange. I am sharing all my personal information to you, while I know nothing about you”.

    2. Beyond therapy, what I find most frustrating and annoying is working with colleagues or coworkers who just do not know how to get along. Sure, we are not expected to get along with everyone, but if it is starting to affect the clients then that is a problem. For instance, being in the mental health field as one of the only few males, I have worked with a lot of females and something that annoys me is that some of them, not all, love to create drama, gossip, and rumors about others. For instance, at my job, I am the only guy and I have two female coworkers who essentially hate each other and for some unknown reason, they both come to me and love to tell me how much they hate the other so essentially, I am in the middle of a war between the two. On a side note, I learned to never take sides ever and to just not get involved. Oh Lord. Due to this war between them, they chose to not speak to the other and not work together which is not only harming our staff harmony, but it is also disrupting the ability to care for our clients. Due to this conflict, it disrupted everything, the team staff became uncomfortable and so did the clients, essentially this conflict is not helping anyone and making everyone’s job a lot harder. Overall, we are not expected to like the other, but we should at least learn to work together for the sake of the clients.

    Reply

    • Mikala Korbey
      Mar 04, 2020 @ 16:53:01

      Jayson, I really appreciated you sharing this example about self-disclosure and how you find yourself sometimes sharing more than you should. I think it is something that gets easier over time and becomes more natural. I too find myself sometimes wanting to disclose more because it feels natural in the conversation with students and it has taken a lot of practice but I have gotten better about catching myself before I say it.

      Reply

    • Dee
      Mar 05, 2020 @ 17:12:11

      Jayson,
      I wholeheartedly agree with your thoughts on self-disclosure. It can be so difficult to not disclose, especially when it is typically the norm to disclose outside of therapeutic settings. It must feel so weird for our clients to spill their hearts out to us, and not know anything about their therapists. I think what has helped me to make sense of this and cope with it, is that clients don’t expect to know more about their doctors, and similar to doctors, we use a medical model. Granted I understand we see more of our clients than doctors do, and arguably we know a lot more about them personally, but our clients trust us to treat them and disclosure can sometimes look more like we aren’t focused enough on our clients or truly hearing what they are trying to tell us. It can also interrupt the flow of things and get away from the client’s point. Nevertheless I agree. Not self-disclosing can still be pretty hard.

      Reply

  6. Becca Green
    Mar 04, 2020 @ 12:21:18

    When I first read through the table the two things that stood out to me that I’ve noticed about colleagues are the disclosure of personal information and social media sections. I have also noticed this personally and heard things from family and friends about the inappropriate self-disclosure from clinicians. I think it can be tough for people to go from giving advice and sharing stories with friends to being a clinician and understanding that there is little room for that type of validation/comfort. I see this a lot with individuals who have lived experience with mental health concerns. I think because of my negative experiences with therapists in the past I have always been conscious of self-disclosure and rarely use it. When I have used it I got consultation around it and followed up with my supervisor after the disclosure (this was literally one time, I can’t think of any other times that I felt self-disclosure would be beneficial to the client). I also think that some people don’t always have the mindset of having a “one-sided” conversation. By that I mean that the conversation is focused on the client’s thoughts and experiences and not at all on the therapist’s personal thoughts and experiences.

    The other piece of social media stands out as well because I have searched colleagues and other professionals and have seen some unprofessional things. A lot of the stuff listed on the list we discussed a couple of weeks ago about professionalism and things to be cautious about posting were posted. I tend to be cautious to make sure my privacy settings are up to date, as well as Googling myself to see what pops up. Better to have people not see anything at all!

    Outside of therapy itself I find that collaborating or communicating with any outside agencies or providers to be the most frustrating. That is partly why I don’t enjoy working with kids. I know that with any age group this is a necessity, but with kids it’s more consistently necessary. Other providers aren’t always responsive, don’t always respect the credentials of a counselor, and in general it can be time consuming to try to work with outside agencies. It involves additional paperwork as well, which is never fun. As an intern I have not had to submit requests for more sessions to insurance companies (my supervisor does that) but from what I know about the process I can imagine that is frustrating as well, mainly if the request is denied but the client needs additional services.

    Reply

    • Shannon O'Brien
      Mar 08, 2020 @ 17:13:03

      Becca – I appreciate how honest you were when speaking abut elf-disclosure and how experience with your own therapists has shaped how you utilize/don’t utilize it. I also really liked your discussion on social media. I didn’t talk about this because I felt that I had a pretty good sense of where I was at with how I use social media. But, you brought up some great points. Especially your point in class about being on dating sites! I mean, that is not something I would have ever thought about! Also, the importance of Googling ourselves is great to bring up again. Keeping all things related to social media as private as possible is a must in my eyes.

      Reply

  7. Nicole Plona
    Mar 05, 2020 @ 11:37:51

    Looking at Table 2.2, I believe the best and most challenging ethical practice to uphold is “Thorough Documentation is Best”. Throughout my internship experience, the most challenging and boring process for myself would be the paperwork and documentation of sessions. In the beginning, I would often struggle with what was important to leave in with progress notes or what information was just “fluff” and could be left out (either making them too long or too short). I think this is the case for most people in the clinical field. There is never going to be a time where there is no more paperwork or documents to complete. It gets extremely overwhelming and can pile up fast which can turn into a very boring, tedious process. Outside of documenting what happens in session/in-office visits, there is the additional collateral contact information that needs documentation from time to time. This includes documenting no-show clients or other follow-up contact efforts. This is important information to keep track of not only for ethical reasons but also for billing and insurance purposes too.

    I also thought that “Caution with Social Media” was an important section to include with these ethical practices. Over the past several years, social media has grown and developed into a huge platform that almost everyone uses daily. Even with privacy settings, people can get a hold of personal information posted on these sites. Because of this, new policies and procedures need to be put into place so that no ethical boundaries get crossed. I would think it’s obvious not to friend request or contact clients virtually outside of the office, however, this might not be so obvious for others. The other thought to keep in mind is censoring the contact you put out into the world on social media. Clients will search for counselors online; it’s important to limit what they will be able to find when they search your name.

    As mentioned before, I do not enjoy doing paperwork or documenting sessions. This is easily the least enjoyable part of this profession for me and is something I find myself putting off until the last second. I tend to have a difficult time scheduling in moments where I can sit down and catch up on all the progress notes that I need to do throughout the week. Along with that, I am not the best at typing; it has never been something I consider enjoyable. I feel as though I would be better at getting paperwork done if I was able to handwrite the information out instead of needing to sit in front of a screen and type all the time.

    Reply

    • Mikala Korbey
      Mar 05, 2020 @ 17:00:15

      Nicole, I appreciated your comments about social media. The day we talked about it in class and started googling ourselves, I noticed there are somethings on the internet when I google myself that I cannot get rid of and when/if clients search for me they will be able to find me. It is kind of scary the huge impact that social media has in our world and how easy it is to find things out about people.

      Reply

  8. Rachel DiLima
    Mar 05, 2020 @ 15:07:43

    1. I think that ethics will be something constantly on my mind when I’m interacting with my clients. For myself, I identified “accurate and truthful billing” and “only practice in area expertise” as the most challenging for me. Through my internship, I have discovered that billing is a headache, and I have accidentally billed for the wrong service, or not billed at all, because I was unclear on how it worked. Although I have since been taught the correct way to bill, it still stresses me out and I know it will be something I need to address more thoroughly in the future. Additionally, I am concerned about falling into the “empathy trap” with billing, and not being firm with billing clients the full amount that they owe. I have had a client have to stop in the middle of trauma treatment because her insurance coverage stopped. It was heart-wrenching to make that call, and I had a distinct feeling that if I had my own private practice, I may have taken her on for free until she finished treatment. I can understand how this can turn into a slippery slope, however, so I need to learn how to be alright internally with firm billing. As for “only practice in area of expertise”, that comes from the desire to know it all to help all. I have a client who has recently begun to show symptoms of OCD, and although I know the basics of Exposure and Response Prevention, a part of me is starting to realize that his issue may be bigger than I can handle with my limited experience. I feel bad referring him out after we have established such a strong alliance, but I also am worried that I don’t have the experience to help him.
    2. There were a few required duties beyond therapy that I find challenging (professional advocacy and case management are at the top), but possibly none more so than working with MCOs. As I mentioned earlier, billing is a challenge for me, and I have been lucky to be in an organization that has a capable office manager who helps with billing and dealing with the MCOs. However. I know this is not the norm. I have seen our manager spend hours on the phone in order to get coverage for clients, and to clarify whether or not certain services are even billable (Is an intake billed as a session? A diagnostic evaluation? A clinical assessment? HELL IF I KNOW). This seems like a daunting and time-devouring portion of my practice, but an inevitable one. All I can do is learn and keep going.

    Reply

    • Dee
      Mar 05, 2020 @ 17:01:19

      Rachel,
      If it’s any consultation you aren’t the only one frustrated with the insurance and billing process. It might help to know that most placements, if you are responsible for processing billing, will make sure you know how to bill and what is billed as what. From my experience at my own placement, you are correct in noticing that it is not typical for placements to process your billing for you. At least it may be comforting to know that your clinic will not want you to bill a client incorrectly, so they are likely to help you in that process.

      Reply

  9. Shannon O'Brien
    Mar 05, 2020 @ 15:43:56

    1. I think for me the most challenging ethical areas for me are documentation and practicing within my area of expertise. I do think I am externally managing these things relative well right now, but internally I definitely struggle. For documentation I think that I do document well. My superior had also stated that I document well. However, what I am most concerned about is how long it takes me to actually write my progress notes. With only 20 clients, I currently have a good amount of time to thoroughly document, but when I work fulltime somewhere and could get between 60-80 clients….that worries me with how efficient I am when documenting. I want to be through, but also be time efficient so I am not ether coming in early or staying late everyday because I am unable to pick out the most important parts of a session to document. When thinking about practicing within my area of expertise, I think it coms down to just wishing I new more about everything and to be sufficient in lots of psychological concept or treatments. This is definitely a high expectation for myself that needs to be checked, but I find myself just wishing I knew more. I have said to a lot of clients “I don’t know much about that. Maybe we can look into it together or I can ask some other clinicians. We can refer out as well if that’s needed.” I know that its totally fine to admit that, and its preferred, but there\ is also something about saying “I don’t know” that can feel weird!
    2. Two things that I find to be difficult are communicating with other agencies outside of my site and dealing with insurance questions. Thankfully, Spectrum does make it really easy to communicate from one Spectrum site to another. However, the second I need to reach out to transfer a client to another facility or have them guest dose for a vacation they are going on, I get really nervous. it most likely because they require different things or have shorter hours they are open, but calling other agencies or reaching out to higher levels of care are always things I dread doing. I also feel like it is a lot of phone tag especially because I am only in the office 3 days a week. When it comes to insurance, forget it, I am SO uneducated (I am still mooching off my parents for a few more months so not having my own definitely effects my knowledge level haha). I try to learn as I go, but it seems like the second I hear something insurance related, it flies right or of my brain. Clients ask questions a lot and I just feel like a deer in headlights when talking about it. Honestly, I try and learn a lot from my clients about insurance as they are the ones that deal with it directly and I have learned a thing or two for sure.

    Reply

    • Rachel DiLima
      Mar 07, 2020 @ 08:30:55

      Shannon,

      I can completely empathize when you say you wish you knew more. I find myself thinking this all the time. Sometimes when I hear other clinicians speak about different interventions or ways to treat clients that I hadn’t thought of, I can’t help but feel out of my depth or that I should know more. I brought it up with my supervisor one time, and she was able to help me see the amount that I DO know, and gave me perspective into my level of training, how much more experience others have compared to me, and how much father I have to go. It gave me some heart knowing that its very normal to feel like I have inadequate knowledge and that even my supervisor sometimes feels the same way.

      Reply

    • Nicole Plona
      Mar 08, 2020 @ 15:50:01

      Shannon,
      I also occasionally struggle with insurance related problems from time to time at my internship location. At my location interns do not have to bill insurance for sessions however, based on the type of insurance there are still copays to collect. Interactions with money can always be stressful and overwhelming without the appropriate staff to assist.

      Reply

  10. Dee
    Mar 05, 2020 @ 16:56:19

    1. The ethical practice I think is the most challenging to uphold is self-disclosure. Before I make it seem like I’m self-disclosing all the time, I want to iterate that I’m not. I merely mean that not self-disclosing in situations where people typically self-disclose or are pressured to, can be difficult. For myself I tend to struggle most with self-disclosure when clients’ parents first meet me or talk to me on the phone. I have what they call “baby face” where I look and sound like I am in high school. Parents without fail always question how old I am, and I ask why they are wondering (knowing full well they are wondering if I’m even qualified), and typically answer with explaining my training and current qualifications, and a disclaimer that if they feel that I am not a good fit for their child they have the right to request a new counselor. This usually addresses their worries but it can be really tough to not just self-disclose. But giving them the answer to the question they are asking, isn’t always going to give them the information they truly want. Other situations that make self-disclosure difficult is when culturally or religiously I have a connection with a client that I can sympathize with but I can’t disclose. This wouldn’t actually give the client what they need, and I recognize that, but typically humans connect socially by shared experiences, and as a counselor sometimes I have to go against what I have learned innately for my social encounters. It can literally be like fighting an instinct, and is especially hard when I genuinely enjoy people and consider myself a very social person. I understand self-disclosure is not appropriate in situations, and why, but it can definitely be difficult.

    2. The required duties I find beyond therapy that I find the most frustrating is billing/dealing with insurance companies and insurance related documents and paperwork. I’ll be totally honest in unprofessional terms: Insurance companies suck to deal with. I understand that I’m dealing with other human beings, but more often than not, the people I deal with don’t have the same mindset, and irritate me to no end when they don’t understand how important it is that my clients have the units they need for therapy. I wish those in insurance and related departments had more education on the therapeutic process because I’m tired of practically selling away my first born to get additional units for my clients. I have definitely gotten a lot better with how to deal with billing and insurance, but it is definitely my least favorite part of being a counselor. Sometimes it helps to swear alone in my office after I make those phone calls or inquiries 🙂

    Reply

    • Alyce Almeida
      Mar 07, 2020 @ 10:23:25

      Dee,

      Your post on self-disclosure really resonated with me. I think it is very hard at times to not want to self-disclose especially for those cultural aspects because that could really benefit the relationship. I think it’s important to remind yourself that it can be useful at times but depending on who it’s for. You said it clearly “This wouldn’t actually give the client what they need, and I recognize that” which I think is what many are lacking when they are self-disclosing all the time. I feel you with it – it’s hard at times!

      Reply

  11. Rachel DiLima
    Mar 07, 2020 @ 08:42:02

    Dee,

    I appreciate your honesty when you speak about your struggle with self-disclosure. When you mention that you find it difficult not to self-disclose your age to parents, I think that you handle this excellently by communicating your qualifications and training. I too have been asked, via telephone introductions with a client, how old I was. The woman felt the need to explain herself after asking it, stating “I just wanna know if you’re a baby or not.” What I realized in that moment was that this woman was agreeing to trust me with her traumas in return for the hope that she will get better. She was anxious. I did the same thing that you did, explained my credentials and that yes, i was in grad school, and then I also told her about my passion for treating people with trauma and how I understood how scary it can be to trust someone new. This helped win her over. I share that with you because I think that you are doing an excellent job handling the “how old are you” question, and that by maybe calling out the elephant in the room (parents are anxious PERIOD about handing their child over to a stranger) and empathizing with it, it may give you a bigger sense of control in the situation. Keep doing the good work!

    Reply

  12. Sarah Mombourquette
    Mar 07, 2020 @ 12:39:07

    I think that the most challenging ethical practice to uphold is the accurate billing section. At internship, I have worked predominately with grant funded programs. Due to this, all of the clients I see are not needing to work through insurance providers and are receiving the service essentially for free. Where this has been challenging is that sometimes it is hard to stay within the time constraints of the grant-funded programs due to the desire to make sure the clients are continuing to receive the services they need. I know that it can often occur where people will blur start and end times in order to ensure adequate services. I think that conversely, after working in a lenient and grant-funded program, I will find it incredibly challenging to switch over to insurance-based services. I have so much frustration with the current health care system that I don’t know how I could justify concluding services for the populations I intend to work with who already have fewer health resources.

    I find that coordinating with other providers is one of the most frustrating parts of being a therapist. I think this is because I have been taught that it is incredibly important to be collaborating and aware of the approaches and services that a client might be receiving in other areas. Therefore, it can be really frustrating when those providers do not get back to you. Along the same lines, I often have to work with clients who are in DCF custody, and it is remarkably challenging to keep in contact with the DCF workers. This is additionally frustrating when you are trying to provide well-rounded services for clients.

    Reply

    • Nicole Plona
      Mar 08, 2020 @ 15:54:33

      Sarah,
      I really connected with your post talking about the difficulties contacting/ communicating with DCF workers. Some of my clients also had DCF involvement in their families and it was never an easy process getting in contact with them when they would call and leave messages. This is definitely part of the professions that could get extremely frustrating after a while.

      Reply

    • Shannon O'Brien
      Mar 08, 2020 @ 17:18:21

      Sarah – thank you for also talking about coordinating with other therapists/agencies. I find this to also be so frustrating and something I dread doing! Collaborating with others can be so hard especially when styles or policies differ. Clients involved with DCF are definitely challenging and it is really hard to work with DCF sometimes. When it comes to what is best foe the client, I feel as if I struggle seeing eye to eye with some DCF workers. Definitely not a fun experience, but I am hoping with more practice with talking with DCF, I can learn how to get what clients need while also following procedures.

      Reply

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Adam M. Volungis, PhD, LMHC

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