Topic 8: Ethical Considerations and Non-Therapy Duties {by 3/18}

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?  Why?

 

Your original post should be posted by the beginning of class 3/18.  Post your two replies no later than 3/20.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

41 Comments (+add yours?)

  1. Jess Costello
    Mar 13, 2021 @ 17:23:20

    Based on Table 2.2, I find understanding multiple relationships challenging, as well as practicing within your area of expertise. Regarding multiple relationships, it may be impossible to predict in some cases where a potential multiple relationship may arise, as well as how to manage the concern and take the most appropriate action. Clients may not always understand why multiple relationships can be problematic, and so it could be hard to manage professional boundaries while maintaining a solid rapport. Similarly, if a client expresses that they may be best served by an intervention outside one’s expertise, the most ethical action would be to refer to another practitioner who is more experienced in that area, but it may be hurtful or damaging to the particular client in the moment.

    As for required duties beyond therapy, at this point in my career I am most intimidated by developing accurate yet flexible case formulations and dealing with managed care organizations, perhaps because they would be approving and reimbursing the treatment that I propose and plan. While I have not had much experience working directly with insurance companies, I am slightly worried about formulating and treating to meet external standards.

    Reply

    • Zacharie Taylor Duvarney
      Mar 14, 2021 @ 11:53:25

      Jess,

      I have the same concerns regarding managed care. While I do believe that the field needs to be more accountable, and that managed care achieves this to some extent, I fear that clients will be asked to leave therapy prematurely. So far, I have had to only justify my approach in counseling notes, which has not been to stressful. However, I am fortunate in that I work for a federally-funded program, which seems to take a more laissez-faire approach to individual counseling sessions. That being said, as someone who wants to eventually open a private practice, I too wonder how difficult it will be to work with insurance providers. Hopefully, as mental health becomes more integrated within the medical model, this will be less of a concern.

      Reply

    • Katrina Piangerelli
      Mar 14, 2021 @ 15:34:28

      Jess,

      I agree, sometimes managing multiple relationships can be difficult. I recently had a client ask me if I would share her business on my Facebook. Of course, I informed her why I could not do this, but I also informed her that it would also impact her as well. People on Facebook may know I am a therapist and therefore could potentially figure out that she is one of my clients. I also had to make sure she understood that it would be be appropriate for our relationship if I was to connect with her on Facebook as well. I think something that could make this even more difficult is working in residential. I know boundaries are a little bit more difficult because of how involved we would be in their lives. Many client’s in that setting see no issue with being friends on Facebook or other social media and I even see staff accepting friend requests from current and past client’s.

      Reply

  2. Zacharie Taylor Duvarney
    Mar 14, 2021 @ 12:09:17

    1.Based on table 2.2, what ethical practice do you believe will be the most
    challenging to uphold?

    Of the ethical considerations listed, I find that thorough documentation will be the most difficult to adhere to. Let me preface my thoughts by stating that I currently adhere to this practice, making sure to always be including the core concepts of the session as well as staying up to date on paperwork (e.g., treatment plans, assessments, etc.). Furthermore, I take a stance of transparency with my clients. I also inform them of how I do documentation and their rights related to documentation within the first 3 sessions. From a personal standpoint, I always strive to be ethical in my documentation.
    The concern I have is related to working within an organization. As has been discussed multiple times in class, I am responsible for a lot of documentation at Spectrum. Furthermore, our documentation is expected to be completed concurrently. Concurrent documentation is a very difficult practice. Also, I am sometimes forced to make decisions about whether to focus more on documentation or other relevant therapy tasks. Sometimes, I am forced to be less thorough in my documentation for the sake of providing therapy with fidelity (which I believe to be the correct choice). It is unfortunate that organizational standards force me to make these considerations (something I hope will be less of a concern in private practice). I assume many of the students in this class will have to work through this very same concern I have outlined, and so I implore people to develop personal systems for improving their documentation.

    2.What required duties beyond therapy do you find the most frustrating and why?

    Again, drawing from personal experience, I find case management to be particularly difficult. It is already so difficult to complete all the therapeutic interventions you intend to execute within a limited timeframe. This task is made more arduous by the demands of case management. Just the process of familiarizing yourself with local resources and contacts is overwhelming, and the accumulation of this data into an easily accessible location even more so. It took me months to familiarize myself with the local resources available to my clients. Case management is especially challenging when you are asked to interact with third parties such as attorneys and DCF workers. It can be very difficult to find time to talk to these people, especially with a full caseload. Furthermore, these third parties often request you meet with them within a certain deadline. I have found it very hard to appease the requests of such third parties when my schedule is already so full.

    Reply

    • Katrina Piangerelli
      Mar 14, 2021 @ 15:38:53

      Zach,

      I agree that documentation can be one of the more difficult things to manage. I think this there is a lot of pressure to have good documentation and a very full-caseload which can be very difficult at times. I also agree that case management is an area of concern and frustration for me. This is one of the duties I have at my current internship and it is sometimes difficult to help different client’s feel hopeful about resources when these resources are so backed up with applications and others that need help as well. The example I gave was regarding housing issues. Housing issues are always a major area of concern and always the hardest to help a family with. I can help them fill out a bunch of applications, but I can’t help with there actually being a living space available that will fit the needs of the family.

      Reply

    • Adam Rene
      Mar 15, 2021 @ 10:48:37

      Zach, I also discussed case management in my blog post. Coordinating with other agencies can be very taxing, but on the flipside it does create new professional connections that can come into play later. Building those relationships with other agenices is a worthwhile endeavor…even though i can detest it sometimes when juggling other professional responsibilities like you mentioned.

      Reply

  3. Katrina Piangerelli
    Mar 14, 2021 @ 15:29:34

    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.

    After reviewing table 2.2, I would say that keeping thorough documentation and only practicing in areas of expertise may be two of the more difficult areas for me. I currently keep pretty thorough documentation, but I also do not work full-time or have a full-time caseload. I imagine with a full-time caseload this may be more difficult to keep up with. This may also change depending on what agency I work for as well because different agencies have different documents you need to keep up with. Currently, this is not a major concern of mine because I am able to keep up with session notes, treatment plans, assessments, and other things I have to manage, but I imagine that other agencies may have more paperwork.
    Another thing that may be difficult is only practicing in areas of expertise. I think this is difficult because I currently work in an outpatient setting where I see people of all different ages and backgrounds. This means that I work with children, adolescents, young adults, middle-aged adults, and older adults. I also work with individuals, couples, families, and groups. With this, it is hard to have an area of expertise in regards to population. I think this may also be difficult if I get a job working with a very specific population and then decide that I would like to work with another population instead. This may happen in my career and I think this is something that I would be able to adapt to and learn from, but also may be difficult at times.

    2. What required duties beyond therapy do you find the most frustrating and/or least enjoyable? Why?

    A couple of things come to mind that I currently do at my internship now such as case management and working with other providers. I think that case management related tasks can be challenging because there are a lot of resources for different populations, but there are also a lot of resources that people may not qualify for or may not be fast enough to be helpful. A good example of this is any housing resources. Housing is a huge stressor for many low income families and it is never easy to find housing for them. This process can take years and often these families do not have years to find an affordable place to live. This makes it really challenging to give these families hope when you know that it will most likely not be a quick or easy solution. Another thing that I think can be frustrating at times is keeping track of other providers such as other services, schools, and DCF. This is mainly difficult because it is not something that we can really bill for and it can take up a lot of time. Managing a caseload and then being in contact with every provider each of those clients has is not easy.

    Reply

    • Zacharie Taylor Duvarney
      Mar 15, 2021 @ 10:38:47

      Katrina,

      I agree that case management can be quite demanding and frustrating, especially when you have a full caseload. Depending on where you work, it is possible that the compendium of resources at your job site is very disjointed and unorganized. Also, it can be difficult finding time to reach out to third parties such as DCF, something I outlined in my original post.

      Something I am doing as an intern is setting aside time in my schedule to compile the materials and resources necessary for case management. So instead of seeing a client, I’ll dedicate an hour to doing that. Perhaps that can help you.

      Reply

    • Kelsey Finnegan
      Mar 15, 2021 @ 14:51:18

      Katrina,

      I agree that case management is one of the most challenging aspects of our jobs for the reasons you listed. It is always difficult when we have to tell clients about the resources that exist for them, knowing they will most likely not be fast enough to be helpful and the application process itself for many resources is often very time-consuming and confusing for clients.

      Reply

    • Paul Avolese
      Mar 17, 2021 @ 17:18:13

      Hi Katrina,

      I had not considered difficulties completing paperwork when I have a full caseload. Similar to you, I am only seeing a handful of clients for my internship and do not have any difficulties completing paperwork. If I run over with a client and fall behind on a progress note, I usually have time to go back within an hour or two. I imagine this becoming more difficult when in a full time position.

      Reply

  4. Adam Rene
    Mar 15, 2021 @ 10:44:46

    (1) I would say for me, the most challenging ethical practice would be around social media. I would place this more as ‘tricky’ for me rather than challenging. I’m quite active on social media – I post pictures of my cats, Kara and I doing things, a joke every Monday, and activities/services put on by my church. While I do have many privacy settings already enabled, it reminds me of the importance that my social media presence has for my profession. I, Adam, am my profession – myself as a person is what I bring to my sessions every single day and I want to ensure that I’m representing myself professionally, intentionally, and truthfully in all aspects. The other challenging one that I wanted to comment on is billing. Having had some experience with billing through my TM job and seeing coworkers get fired for fraudulent billing, it’s just so important to maintain awareness of how slippery the slope that billing can be. It’s never worth it to over-bill.

    (2) With regard to required duties beyond therapy, my top 2 in terms of frustration/least enjoyable are working with MCO’s and Case Management. I have worked with MCO’s through my TM job and the majority of the time, everything is fine and everyone gets along. There are certain MCO’s that are sticklers for an exact diagnosis, exactly what was done during the 3 months of authorized services, and legitimate plans on what you plan to do for the next 3 months. There are also certain MCO’s that only need the diagnosis code and how many units you want and they don’t ask questions. But the kicker for me is around situations where clients didn’t receive notice that they needed to do something about their insurance, the insurance lapses, and my service has to come to a screeching halt. Historically when this happens my clients have to jump through so many hoops to get things running again and often times it has led to the service discontinuing. For Case Management, I often enjoy this aspect but it can get easily overwhelming when a client presents with so many problems that could be addressed. I get the feeling that I want to ‘solve them all’ and can oftentimes feel like I’m not doing enough. But that speaks much more to my own professional development rather than the client themselves.

    Reply

    • Kelsey Finnegan
      Mar 15, 2021 @ 15:03:23

      Adam,

      I also find working with MCO’s and case management duties to be the most frustrating required duties beyond therapy. Case management can definitely be overwhelming, and I also sometimes find myself feeling like I’m not doing enough for my client’s in this area. I think a true lack of adequate resources in the community for many of the populations we work with contributes to this, but I think some of that feeling comes from my own negative automatic thoughts (believe it or not! haha).

      Reply

    • Jess Costello
      Mar 16, 2021 @ 21:43:52

      Hi Adam,

      As someone who frequently sees your Monday (or should I say pun-day) jokes, I like that you brought up considerations that go into how you’re portraying yourself on social media and how that could affect your professional reputation when you are bringing so much of yourself into your job. Especially for anyone thinking of going into private practice down the road, your identity is your business and how you reflect to others.

      I can also relate a little bit to what you said about not feeling like you’re doing enough with case management. Often I find myself wanting to help a client solve a problem or access a resource that’s beyond my control or ability as a counselor, or get frustrated when the relevant agencies seem indifferent.

      Reply

    • Melissa Pope
      Mar 17, 2021 @ 14:51:14

      Adam,

      I do not think you are alone with finding social media to be a challenge to navigate for professionals-especially in our field. It is very difficult on the online world to not blend your professional and personal life; thus is why I jumped ship a few years ago. However, social media does have so many benefits, and hopefully as we progress into the future, developers will be able to find a way to increase those privacy settings- so that we too (the professionals) can have a private life. After all we are human too- and like to have fun.

      I have never worked with MCO, but I am dreading it. Especially when I go into private practice someday.

      Reply

  5. Kelsey Finnegan
    Mar 15, 2021 @ 14:44:29

    1.) For myself, I think thorough documentation will be the most difficult ethical practice to uphold as a professional counselor. It seems there is a very careful balance between saying too much and not enough when it comes to writing client progress notes. Additionally, what might be considered writing “too much” in one supervisor’s opinion may be saying too little from another supervisor’s point of view, and documentation formatting/expectations can vary significantly across settings and managed care organizations. This requires a lot of flexibility and mental energy, which can be challenging when pressed for time.

    2.) In terms of expected duties beyond therapy, I find paperwork, managed care organizations, and case management to be the most frustrating. My reasons for finding paperwork and managed care organizations frustrating are similar to my previous response. Additionally, as discussed in chapter 4, managed care organizations’ overemphasis on the medical model often requires therapists to compromise professional counseling ethics and standards of client care, which sounds extremely frustrating (and unethical). I also find the case management component of counseling to be discouraging at times due to a lack of adequate resources for low-income and/or disabled clients.

    Reply

    • Adam Rene
      Mar 15, 2021 @ 16:45:13

      Kelsey, documentationm was a strong contender for my least favorite and I’m glad you indicated that comment about thorough documentation. A colleague of mine shared a cautionary tale about being too detailed in notes with regard to a court case she became involved in due to a client. This colleague shared that her detailed notes were very much used against her during a court case and ever since she has made her notes much more succint and only including what was needed for documentation.

      Reply

    • Ashley Foster
      Mar 18, 2021 @ 12:16:09

      Hi Kelsey,
      I agree the paperwork portion of our position feels like taking on a mountain at times. I personally am not a fan of all the paperwork either. I think too, this varies site to site. Working inpatient, I honestly do not do too much paperwork even in our assessment. On the other hand, work at Spectrum in an outpatient setting, I am always rushing to complete paper work within the session time and I find myself having a key to copy and paste from to keep up. This is not ideal. I think it’s figuring out where you want to be and how much paperwork you want to take on as it varies.

      Reply

  6. Paola Gutierrez
    Mar 15, 2021 @ 18:24:03

    1. Based on the table, I find that thorough documentation challenging. The specific information that is needed for documentation can vary widely across agencies and even depending on the supervisor. I strive to clearly and briefly present what was done in the session (i.e., what interventions were used), client progress and response to intervention without divulging specifics. Thorough documentation has been especially difficult at the agency level to manage during the pandemic – an audit review at my internship site last fall indicated that there were some gaps in our documentation that needed to be resolved, which was especially complicated as everything was via telehealth. Accurate and truthful billing is another issue that I have seen at other places I’ve worked, especially those that were productivity-based in which colleagues were disciplined/fired for fraudulent billing. Self-disclosure is another area that can be tricky to navigate at times – I generally don’t disclose much about myself with my clients, but in the occasions that I have, I find myself wondering if I revealed too much or if it was inappropriate.

    2. Paperwork and timely documentation is something that I generally manage well right now, but can foresee becoming challenging with a full-time caseload. In the past, I’ve seen colleagues take weeks (even months) to complete progress notes or update assessments/treatment plans. Missing/late documentation was not only unethical (and against agency policy) but eventually created inconsistencies in treatment.

    I didn’t do much case management work during my internship, as I was in the (rare) position where my clients were not involved with other agencies/supports (such as DCF). I would occasionally send applications for housing to clients but would not help them complete applications in outpatient sessions. However, in one case, my client was not able to engage in therapy because she had so many unmet basic needs (housing, untreated health problems, lack of transportation, access to food, etc). I found myself spending more time trying to help with these basic needs and because of that, unfortunately, we couldn’t make much therapeutic progress. I did more case management work in previous positions, such as placing referrals for additional supports, helping with housing/food applications, meetings with DCF, etc. This work was difficult to manage and coordinate alongside therapy, especially structured and targeted treatments like CBT.

    Reply

    • Jess Costello
      Mar 16, 2021 @ 21:55:10

      Hi Paola,

      I agree that finding the right balance of documentation, where you’re providing sufficient information but not too much, can be difficult and varies depending on the supervisor. Telehealth complicates things too when supervisors and others who would be reading the notes are not necessarily in the same room. I also try to limit my self-disclosures but wonder if the ones I do use are too much, or focus too much on myself and not what the client needs in the moment.

      Reply

    • Melissa Pope
      Mar 17, 2021 @ 14:56:08

      Paola,

      I did not write about documentation being an issue for myself, but I can completely see where it would eventually become a problem, especially with a full case load. And I feel that it will be compounded for first 5 years even more, as we are new to the field and, still trying out different ways to figure out how we function best in our professional lives. I will say though, from knowing you very briefly in other classes and practicum, that you are very thorough and organized- and see no need to worry about this. I am certain that your progress notes will be tip top, and passed in on time.

      Reply

  7. Melissa Pope
    Mar 16, 2021 @ 17:27:58

    For myself the only 2 ethical practices that I find or may find most challenging are: Excessive wording/self disclosure (surprise surprise), and only practicing in area of expertise. With the population that I work with (children) I find myself trying to create normalcy with experiences or emotions, through disclosing personal experiences. I typically will take out all the details and only keep to the “big picture” but sometimes after I say it, the words “Melissa don’t disclose information” rings loudly in my head. Thus far, I do not believe I have ever shared information that is too personal or that would enhance client’s distress or ruin rapport but I do fear, if I am not more mindful as I am processing what to say, that someday I may mess-up.
    I also tend to be an individual that likes to “tackle the world” and very much seeing myself taking on clients in the future, that I may not be equipped to handle. It is very difficult for me to reach out for help, when I need it and a part of myself (personally and professionally) that I am continually trying to perfect. I do get very frustrated when “I can’t do something”, due to lack or knowledge or skill, and will research, read, and practice until I can do it. This approach will not always work, and knowing my limits is a frustration that I just have to get used to.
    The two duties beyond therapy that foresee myself least enjoying are working with co-workers, and dealing with managed care. Surprising to most people, I actually enjoy working alone and keeping to myself as much as possible. I enjoy day to day pleasantries, and small conversations- however I do not like feeling inclined to create a close relationship with people I work with. I foresee my attitude toward this matter, impacting work relationships that could be at the expense of a client, which is something that I do fear. Dealing with MCO, I think is self-explanatory- the time and work needed to have a client accepted for reimbursement is just a nuisance, but an obvious necessity of the job.

    Reply

    • Paul Avolese
      Mar 17, 2021 @ 17:14:12

      Hi Melissa,

      I have had similar experiences with self-disclosure. Like I mentioned in my post, I think it can be a trial and error endeavor. We are not always going to believe we have said the right thing, but it may be helpful in a way we had not considered as well. Also similar to you, I prefer to work independently as opposed to a group setting. I am hopeful that the mental health field is a little less superficial when it comes to the work environment, but am also grateful for telehealth for this very concern!

      Reply

    • Anthony Mastrocola
      Mar 17, 2021 @ 20:56:46

      Hi Melissa,

      I also noted area of expertise as an area of difficulty for me. In a helping profession I think it’s only natural for all of us to want to help people. I think your desire to continue learning is admirable and excellent for anyone in this stage of our career.

      Reply

  8. Paul Avolese
    Mar 17, 2021 @ 09:55:10

    Self-disclosure is something I have experimented with throughout my internship. I think, at times, it can be an effective way to relay information or show empathy. Developing boundaries with self-disclosure has required some trial and error on my part. The first question I always consider is, “how helpful would sharing this information be to the therapeutic process?” For me, this usually comes down to an opportunity to enhance the therapeutic relationship. I think it’s important for clients to see counselors as both professionals and also humans to build trust in the therapeutic process. At the same time, I am careful with my wording and try to be vague with details while simultaneously providing the client with an experience outside of their own that they can potentially relate to more objectively.

    Sometimes, I think my desire to disclose is partially due to my own insecurities and that my wanting to share my experiences serves as a way to validate myself in my counseling role (e.g., “I’ve been there,” “I’m just a person too”). Because of this, I tend to shy away from disclosure even though I consider it often. I am still developing a personal philosophy on using self-disclosure and do not want to project those expectations onto clients who may be perfectly comfortable with a more traditional counselor/client relationship. Comparatively, some clients want to learn more about me than I am comfortable sharing with them. I am realizing as I am writing this that I have a lot of guilt around closing myself off that I need to process. Even though I do not give in to this guilt in session, I have never really considered it.

    Beyond therapy, professional advocacy is an area I have struggled with in many professions. I think that especially in our field, it is important to advocate. However, recognizing that the world is such a dynamic place with different people, philosophies, and experiences can make it difficult for me to have confidence advocating outside of the field. I try to respect others’ experiences and journeys through life and recognize not everyone values mental health as much as I do. Because of this, I tend to push for incremental change on a smaller scale (i.e., working with clients, advocating both actively and passively with people I meet). I think I have the potential to professionally advocate on a larger scale, but have not figured out the best fit for me yet.

    Reply

    • Anthony Mastrocola
      Mar 17, 2021 @ 20:48:53

      Hi Paul,

      I find that I approach the topic of self-disclosure in a similar way. Reflection is important when engaging in self-disclosure. I agree that when considering self-disclosure, I often ask myself who is the beneficiary. Lastly, we both agree that a bit of self-disclosure is necessary to promote genuineness and authenticity in session.

      Reply

    • Bianca Thomas
      Mar 18, 2021 @ 11:06:52

      Paul,

      I really appreciate your approach and reasonings behind actually using self-disclosure. I truly believe that, if done right, self-disclosure can truly enhance the therapeutic relationship and the individuals belief that change can occur, using us as their model. But, like you, I also understand needing to be vague at times or careful of the approach and wording taken. I thoroughly appreciate your vulnerability and honesty with regard to your reasoning behind self-discloser, using it as a way to validate yourself. I believe that is a really important insight to have about yourself and can truly help you become a better clinician.

      Reply

  9. Anthony Mastrocola
    Mar 17, 2021 @ 20:45:14

    (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.

    Based on Table 2.2, I believe the most difficult ethical practice to uphold is to “only practice in area expertise”. I find this to be most difficult personally because of the stage in my career. I certainly would not consider myself an expert in any specific treatment approaches/modalities, or disorders. I am confident in my ability to use CBT to primarily treat anxiety and some depressive disorders, but I am certainly not an expert. That being said, I find difficulty drawing the line between developing my skill-set and experience, and expertise beyond my knowledge-base. I think after a couple years in the field as I gather more experience and begin to refine my skillset to a specific specialty, I think I will be better equipped to define my area of expertise. For now, I think the line between area of expertise and general competency is blurred. The most important factor for now is to learn enough to understand what I do and do not know.
    I think this ethical practice is generally difficult for many people in the field (from my own personal experience). In my opinion I think the “clinical toolbox” idea associated with eclectic therapy may be the cause of the challenge to uphold this best ethical practice. I think the reason is because professionals who identify as “eclectic” claim to have an extensive skillset that naturally contradicts the ethical practice of only practicing in an area of expertise. While some professionals proudly state that they have an extensive clinical toolbox, they’re saying that their area of expertise expands across diagnoses and presenting concerns. In a CBT-based program, many of us do not share the same perception associated with eclectic practice, however, I believe this idea is primarily sustained by training programs that do not subscribe to specific evidence-based practices.

    (2) What required duties beyond therapy do you find the most frustrating and/or least enjoyable? Why?

    I get most frustrated by the extensive electronic paperwork at my internship sight. Paperwork gets frustrating because it takes away from clinical ability at times. For instance, when paperwork piles up, sometimes clinical documents are reviewed so much that I feel drained when it comes to actual sessions later in the day. Some of the paperwork includes reaching out to insurance to request for extra sessions, modifying treatment plans created by past clinicians, modifying (incorrect) diagnoses placed by past clinicians, and periodically doing various specific documents depending on needs. I am fortunate to not have to do much case management work. I find this job to be most enjoyable when the demands of the job best support clinical ability and responsibility.

    Reply

    • Bianca Thomas
      Mar 18, 2021 @ 11:03:18

      Anthony,

      I think your recognition of your skills, your limits and your abilities is incredibly insightful. I also agree that the line of expertise and general competency, as this stage of our development in this field, is incredibly blurred. I also really appreciate your ideas around being “eclectic” and the fact that you truly cannot be an expert in many different fields; as well as the challenge in working in an environment where people are not true experts in one theoretical orientation, or even the same one as us.

      Reply

  10. Bianca Thomas
    Mar 18, 2021 @ 10:59:12

    (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.

    I think, for me, the most challenging ethical practice is not using self-disclosure. I believe that I know the limits of what to tell and what not to tell, but I truly believe that the way to help people is to connect with them on a deep, emotional and intellectual level, and I just really find it hard to do that when the individual knows nothing about you. The individuals in my life that I have helped the most have known me, my story and my life at a very intimate level, and they have told me that knowing my life and what I’ve overcome have been the things that have helped them believe they are capable of change as well. So, in not being “ethically able” to disclose information that I truly believe would be helpful for the person is very challenging to me.

    (2) What required duties beyond therapy do you find the most frustrating and/or least enjoyable? Why?

    I find the intake process most challenging, just due to the process my company requires. I don’t believe you truly get the information you need to get an accurate diagnosis, or to even really understand the person because the questions are targeted towards topics that don’t really get into the root of the individual’s problems. So, you have to do that long intake, and then your own intake and information gathering afterwards in order to even really understand the person. I just find it unnecessary and annoying for the client.

    Reply

    • Ashley Foster
      Mar 18, 2021 @ 12:09:41

      Hey Bianca,
      I agree self disclosure is one that is tricky. I find this one especially hard when you identify yourself within your clients and want to instill hope or change. I think there is a balance, and asking ourselves “why am I talking” is an important question to keep in mind. It’s human nature to want to connect with others and be able to sympathize with them, but we have to remember our boundaries as providers.

      Reply

    • Taylor O'Rourke
      Mar 18, 2021 @ 14:46:23

      Hi Bianca,

      I agree that the lack of self-disclosure during therapy is a really difficult task for us clinicians. Relationships and friendships are supposed to be two-way, so keeping up with a one-way relationship with a client can be tricky. There have been many encounters with clients where I felt as if I should disclose more about myself, but kept it extremely limited even though I feel like my disclosure may have helped them. However, this is not what therapy is (or at least CBT). I think as we grow professionally, we may become more comfortable with small amounts of self-disclosure which is something to look forward to.

      Reply

  11. Ashley Foster
    Mar 18, 2021 @ 12:03:56

    1. When examining table 2.2, I find that the concern of “only practice in area expertise” is one of the more challenging ones. For myself and I’m sure others in the field as well, we want to be able to help our clients with all their presenting problems and we may feel that we can take on all of it even though we may not be qualified for all the areas of concern. Specifically for myself, I think of individuals with trauma. I have basic training from our classes in treating trauma and teaching grounding techniques, but I do not have much experience in treating trauma through exposure therapy with actual clients. I find though, many individuals I work with at my internship and on my inpatient unit have some level of trauma. In many ways, I know the basics to treat trauma, but there is much to learn before I implement the treatments in session. I need to remind myself at times that I’m still learning and it’s going to take time before I master these skills. That is why supervision I find is so important and continuing education so I can be the best clinician I can be for my clients.

    2. I find case management the least enjoyable with our job as a clinician. Working at Spectrum, there are many sessions where sessions are spent researching housing options, food banks, government funding, and or referrals to medical physicians such as primary care providers. For myself, this is not ideally what I want to be doing during sessions. I rather be implementing CBT interventions and it is frustrating to be doing these tasks instead. Although I see the importance of aiding in these searches and needs for this population, this is not what I was trained to do.

    Reply

  12. Olivia L Corfey
    Mar 18, 2021 @ 12:35:42

    Based on Table 2.2, what best ethical practice do you think is the most challenging to uphold? Explain.

    Based on Table 2.2, I believe documentation will be a challenging aspect. More specifically, staying up-do-date on documentation is currently time consuming and this is without a full case load. Therefore, time management is something I will need to be mindful of and work on improving (Unless I can find more hours in the day somehow!). I also find intakes to be challenging as these intakes are thorough and intensive and the patients typically have quite complicated and dynamic lives. However, this will become easier with time and practice.

    What required duties beyond therapy do you find the most frustrating and/or least enjoyable? Why?

    As for required duties beyond therapy, I find doing research to be the most frustrating and least enjoyable task. However, this is an important and necessary aspect when it comes to utilizing the most effective evidenced-based practice. Also coordinating with other agencies and insurances is unpleasant as others have mentioned. Oftentimes it is difficult to get a hold of or obtain direct answers from others.

    Reply

    • Taylor O'Rourke
      Mar 18, 2021 @ 14:43:58

      Hi Olivia,

      I totally agree with you that documentation is super time-consuming and that is with us working part time, I cannot imagine how much time it will take us once we are working full time after graduation. Of course documentation is a crucial part of therapy, as our notes help us stay up-to-date as you mentioned, but it can certainly become tedious over time and challenging to keep up with during a busy day/week.

      Reply

    • Kara Rene
      Mar 18, 2021 @ 20:53:07

      Olivia,

      I deeply relate to your comment about staying current on research! I have often wondered and worried how I am going to manage to do this, particularly with how little non-productivity time is available in the day! It doesn’t help that it can at times be difficult to find trainings that are truly helpful!

      Reply

    • Paola Gutierrez
      Mar 19, 2021 @ 12:51:29

      Hey Liv – I also worry about how I’m going to set aside the time to research when I have a full caseload. It takes time to find, read, and analyze research. Unfortunately it doesn’t seem like it’s considered as “valuable” or “productive” work even though it’s an important component of providing evidence-based, ethical, and effective interventions with our clients.

      Reply

  13. Taylor O'Rourke
    Mar 18, 2021 @ 14:32:40

    One of the best ethical practices that I think is most challenging to uphold is thorough documentation. Documenting what our clients say/do must be extremely extensive, especially when working in a community mental health setting or agency that requires it. Many times when I have conducted intake evaluations, I feel as though I have left out some details as far as information that I would like to gather from my client. Though there is nothing important left out, I often feel as though there are so many things required for documentation that I forget to ask further questions that would benefit treatment planning. I feel as though one area that I often overlook is attempting to contact clients when they no-show appointments. I surely do my best to document every time I reach out to a client, whether it be via phone or email, but sometimes when my day is extremely busy, I may forget to document that I contacted them. This of course does not leave a paper trail which is what is needed to ultimately unsuccessfully discharge a client due to lack of attendance. Another best ethical practice that I think is difficult for some counselors to uphold is utilizing evidence-based practices. Though all of us in the CCP program have been extensively trained in CBT, not all therapists out there have been and may still be using non-EBP.

    I think the duty beyond therapy that I find most frustrating and least enjoyable is the documentation aspect. As I mentioned previously, there is so much documentation required in public agencies that sometimes I feel as though I do more writing than therapy. Also, at times I feel more like a case manager because of the types of things to discuss with my clients rather than their mental health counselor. I like to be able to utilize the CBT skills that I have learned in the CCP program, so when I spend more time talking about other basic needs with my clients, it is not as enjoyable for me.

    Reply

  14. Mariah Fraser
    Mar 18, 2021 @ 17:29:20

    I think that documentation will likely be the biggest challenge for me due to my poor time management skills. Staying up to date with all of the notes I have to write has been hard even now during my internship, so I can’t imagine what that will look like with a full case load. The intakes that we currently conduct at my internship site are extremely thorough and I could see how easy it would be to fall behind. Gathering all of the information that is important to the client and the case formulation is essential and ideal to collect during the intake itself. So not only keeping up with documentation but also being timely as well – staying on task so that I don’t run over during session (thus reducing the time I’d have to document).

    I find intakes (the extensive ones conducted in PHP) to be a little annoying with the 25 different tabs of information we have to go through. There is no easy way to get through an intake in less than an hour; and this is without taking any breaths. I know that all intakes are that extensive, which is a relief. This can be especially difficult for clients who go off topic and require a lot of redirection.

    Reply

    • Kara Rene
      Mar 18, 2021 @ 20:49:56

      Mariah,

      I can especially relate to having difficulty keeping sessions to 45-50 minutes so that I have time for documentation and to breathe, especially with clients I like or clients who are more chatty and difficult to keep on task or are more crisis-prone. I trust that we will get better at those boundaries with time! My supervisor recently reminded me, as I was talking about feeling bad for cutting off a client to end session (after running ten minutes over), that staying accountable to ending session on time also provides valuable social feedback to our client in terms of respecting boundaries and staying organized while conversing!

      Reply

    • Paola Gutierrez
      Mar 19, 2021 @ 12:55:06

      Hi Mariah – as a kind of follow-up to Kara’s comment on your post, I also find time management during sessions as challenging. Right now, I have the time to go the full hour with my clients, but this might not be the case when I have a full caseload. Ending sessions on time can be difficult, especially with more talkative or crisis-prone clients. I also find that many of my clients will show up for sessions even just 3-4 minutes late with telehealth – even that amount of time can make a difference in a session. Pacing and timing is something I definitely have to work on and get better at.

      Reply

  15. Kara Rene
    Mar 18, 2021 @ 20:44:27

    (1) Personally, I find confidentiality tricky. Not in terms of the broader strokes- not talking to your friends about your clients by name, etc. But when working with children with parents who have differing custody situations I find this especially difficult. I’m thankful to have supervision so that I can ask someone else if I need a release or not! In addition, when working with children it can sometimes be difficult to decide what to tell a parent and what to keep in session.

    In the broader sense, I have noticed that at times the responsibility to make sure that clients understand informed consent (as well as the other paperwork they are asked to sign) gets glossed over by some practitioners. I have particularly noticed this with DCF workers who have clients sign paperwork with the intention of filling it out later (eek!) and intake clinicians who have the pressure to get several documents signed, complete an extensive comprehensive assessment, obtain multiple assessment measures, and complete documentation in an hour and a half. I was recently told to go through the intake paperwork as quickly as possible to leave as much time for the comprehensive assessment as possible, and I am a little bit uncomfortable with that- I think it’s important for our clients to understand what they are signing! Ironically, particularly in community mental health settings, sometimes the clients have had so many services that they care less about what they are signing than I would hope for them to.

    (2) Like many, I find case management to be difficult at times. However, after being a case manager for several years, I have also had to learn when NOT to do case management! Something that my supervisor told me that has made me less loathe to do case management is to remember Maslow’s hierarchy of needs- if my client doesn’t have housing, they can’t work on feeling less depressed very effectively, and if I help them with housing, it will help to build rapport. I do find it very overwhelming to try to stay on top of all of the community resources available, and wonder how I will keep my awareness of resources sharp as I spend more time away from the world of solely case management.

    Reply

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Adam M. Volungis, PhD, LMHC

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