Topic 8: Ethical Considerations and Non-Therapy Duties {by 3/23}
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 3/23. Post your two replies no later than 3/25. *Please remember to click the “reply” button when posting a reply. This makes it easier for the reader to follow the blog postings.
Dr. Adam M Volungis 
Mar 19, 2023 @ 18:49:01
1. I could see other professionals finding only practicing in area of expertise to be difficult to uphold. I could see this being a problem because of the thought that they want to help them in various areas of their client’s life. However, this can then become dangerous of a clinician attempting to give advice or trying to help out when it is an area that they should not be touching. There are areas in mental health that others will specialize in. This could be eating disorders, substance use, trauma, and more. If you are not specialized in a particular area, then maybe you should consider referring out.
2. Documentation is definitely the least enjoyable process. From what I have heard, some agencies rely heavily on documentation than actually meeting with physical clients. There are many areas in documentation that someone will never read or look at again, but some places require so much. We also put so much time and effort into our notes, but then are not compensated for it and could fall behind on notes due to not having enough time to complete them. Group notes, however, I have found to be incredibly easy and as long as the patient has been there before, you only really have to enter in the subjective area and copy and paste the rest.
Mar 22, 2023 @ 09:52:46
Jenn,
I think documentation is an interesting point – I feel like where I’m at now, we do our treatment plans, our progress notes each session, obviously risk assessment if something comes up, and then a termination note. It’s not as much as I feel like I’ve heard other people are inundated with! It’s not my favorite thing, but it’s just like okie dokie I’ll write that note now. As I’ve been interviewing at different places, documentation is a bit different everywhere you go, with some asking for much more, asking for it at certain deadlines, or making sure you update other staff of how sessions went etc., which adds some stress to the whole process. The other thing I don’t have much experience with and am unsure of, (could get used to but might feel weird at first), is concurrent documentation/note-taking. It feels weird to have a client in front of me and take notes at the same time – it makes me wonder about the relationship or if the client feels like I’m not listening. I think that’s a matter of getting into a good groove, balancing the personal touch with being efficient at notes.
Interesting to think about. Thanks!
– Katie
Mar 21, 2023 @ 00:31:48
The ethical practice that I have seen other professionals and myself struggle with is social media content. I saw some professionals share their personal information and post work related content that is unethical and unprofessional. Also, it is easier for personal information to be leaked to clients as social media like facebook and instagram promote accounts associated with your close friends or friends of friends. Another challenging ethical practice is self-disclosure. I find that it takes a good understanding of the client and the therapist relationship. I see that professionals tend to share information that does not provide any benefits for the relationship.
I found that working with the client’s external support systems like DCF workers or PCP is frustrating. I found that many of these systems require specific ways of communication like fax that makes it more time consuming. Also most of the time, It has four days to get a document signed or just processed. I hope that this communication gets better in the future.
Mar 21, 2023 @ 09:31:21
Hi Moises,
I 100% agree with you about social media. I have also seen way too often the amount that people share about their lives on a social media platform even when they are in positions such as being a counselor. Also, in terms of working with external supports, I agree that this can be the most difficult to deal with! You would think with technological advancements that they might be better and quicker with responses, but that is not always the case.
Mar 22, 2023 @ 14:46:00
Hi Moises,
I totally agree that social media presence is a tricky area. I too have seen other providers posting things that are a little off color. I could see where self-disclosure could be tricky as well. I try to be really mindful about how and when I decide to self-disclose with my clients. There are some times that it could definitely be harmful to include a client in your life in that way.
Since I am working with kids right now, I also find it overwhelming sometimes to keep up with the amount of providers in their lives. For some clients, I find myself involved with so many people (parents, additional family members, schools, IHT, mentors, and PCPs). It helps to stay organized, but I can definitely see where it can be frustrating.
Mar 22, 2023 @ 15:04:05
Hi Moises
I totally agree about working with DCF and other agencies like parole, probation etc can be very frustrating- and honestly I am never sure even with a release what I should be saying to them. I feel especially uncomfortable speaking with DCF – there should definitely be more clear cut guidelines about what and how to communicate in these exchanges. There is definitely room for improvement that would make the necessary evil of case management and working with external supports and other agencies a little less unpleasant.
Mar 22, 2023 @ 22:12:53
Moises,
I definitely agree with your point about working with other providers and how it can be stressful. I have an IHT case right now and the client has so many people involved in her care (me, the school, an attorney, an educational advocate, a lawyer, a DCF liaison, and a care coordinator), and trying to get everyone on the same page and communicate with everyone can be so difficult. Not to mention how time-consuming it is to play phone tag trying to talk to someone, then leave them a message, be in a session when they call, and have to call them back. I also think that keeping a professional social media presence is something people need to keep in mind. I’ve tried to really limit my posts and almost none of my social media sites are public to minimize the chance this becomes a problem. Thank you for your insight!
Mar 22, 2023 @ 09:46:40
I think one of the most difficult ethical practices to uphold, for myself as well as other professionals is keeping a good social media presence. I think this varies, with some people definitively crossing the line with obviously unprofessional photos or posts, like excessive drunk photos for example, to others actually using their platforms to promote their mental health practice in positive ways – spreading awareness, sharing tips, etc. Obviously that last one is a good thing – I just feel like it adds a whole other component where your social media then becomes an added work task to keep up with. But I do see the benefits to that, especially in private practice. On the other end, I feel that I don’t really post anything unprofessional – but I do, for example, sometimes share things that might be considered political. Part of me is of the belief that these aren’t political stances, they’re fundamental values (i.e. posts that are “heated” say about women’s rights) that I have no desire to compromise on or hide. At the same time, I understand how it might look to others in the professional sphere. I find that I just keep all my pages as private as possible, but the truth is that you simply don’t know who is looking/how they’re seeing things etc. You never know who knows who! This has led me to just use social media much less, but then I feel some resentment towards that, too, if that makes sense.
I’ve said it before, but I’ll say it again – case management type things are my least favorite part of the work. I don’t mind doing my own documentation or whatever it might be, but seconding what Moises said above, I do not enjoy coordinating care between other providers, especially providers who might be overworked/overscheduled themselves. That tends to end in a lot of phone tag – also because during internship/school I don’t have the availability to always take their calls when it’s convenient on their end. While I do like advocating for my clients, the whole back-and-forth coordination is just not my favorite part!
Mar 22, 2023 @ 14:07:15
Hi Katie
I had not thought about social media much before but it prompted me to look at my own and to see what a client would see if they were on my profile. It is interesting how we seem to think of our social media as “ours” or for friends and family but the truth is anyone can see based on your settings- your point about political posts is definitely true! I think its important just to make sure your settings are private where possible to protect clinician and client. I also 100% agree on case management being the worst.
Mar 22, 2023 @ 21:58:31
Hi Katie,
I think you made a really good point about the importance of maintaining a professional or even benign social media presence. I have a similar experience with posting things that are political-related but to me (as you said) it’s more about basic human rights. At the same time I can understand though how a client may not want to know any of that information about us, though, especially if they have differing opinions and if it could potentially harm the therapeutic relationship. I have all my social media private as well except my goodreads, and honestly I feel like some of my reviews could even be interpreted differently by someone else reading it so I feel like I should block that one off too! It’s definitely a good reminder overall just to be mindful of anything we’re posting at all/its actual visibility to the public.
Mar 23, 2023 @ 16:07:33
Hi Katie,
I agree that I also hate case management work. I understand helping out in the behavioral health area, but when it comes to external things, housing, other programs, etc., I feel as if it is not in my job description and the reason why I am not a social worker. The phone tag is definitely the most frustrating or when clients don’t follow through.
Mar 22, 2023 @ 13:58:40
While I think everyone is a little different, for myself the two ethical challenges that may be most difficult for me is caution with self-disclosure. I tend to be a little more open than some with my clients and they feel comfortable asking me things about my own life, while I can’t say this has ever become an issue- I certainly could be a little more closed off with clients and could certainly make fewer self-disclosures. I think I got into the habit because substance use patients go through clinicians so quickly and have a lot of issues trusting and opening up, I have learned with this population it can be helpful at first to create rapport if they see you as more human, which involves some disclosure- but I think I can be more contentious in this area. Maybe documentation too- not sure how else to say it but documentation sucks and I also have pressure from my agency to keep notes pretty brief, I feel like sometimes I have left things out of notes that later on seem more relevant to me than they did a session prior for example. I can improve in this area.
I like many of us in this program do not enjoy paperwork or case management…. not sure who does really. Especially at Spectrum I just complete a lot of documentation and paperwork which I know for a FACT will never be read or looked at again, and then will be pointlessly and arbitrarily updated in another 90 days. I find this frustrating because it is a waste of my time, as well as the clients time – clients who by the way very rarely attend sessions, and when I do finally get them to show up, I have to force them to update documentation instead of using that session to do anything meaningful. Case management I also really do not enjoy at all. I haven’t had to do a ton, but it is definitely not ever going to be my favorite thing.
Mar 22, 2023 @ 14:50:17
Hi Lexi,
I agree documentation can be an overwhelming part of conducting therapy. I often find myself dreading writing them. I think as I get more comfortable it will be a speedier process, but for now, it can be super annoying.
I can totally see why it would be frustrating to have a client filling out documentation when you haven’t seen them in a while. I personally don’t mind case management, but there is also no way I would ever take a job solely doing it.
Mar 22, 2023 @ 22:03:46
Hi Lexi,
I really appreciated reading your point about self-disclosure and how for different populations this can be so beneficial to clients, like with substance use and those who may lack trust in providers as you said. I feel pretty similar, I feel like I have done self-disclosure here and there and it’s always been for the “right purposes” such as for it being for the client’s benefit and/or for building rapport, but I’ve always felt weird afterward and tend to overthink about what I shared and maybe how the client interpreted it. With that said I really resonated with your statement of just being more mindful in this area, and I think it’s definitely something we’ll understand better over time.
Mar 23, 2023 @ 10:40:28
Hi Lexi
I have observed at Spectrum that Clinical Supervisors are very skilled in making progress notes immediately passing along a report of 8 or 7 people that they have seen the same day. These are also short sessions, but still, I admired the talent of doing it. One of my main problems is that I cannot type all notes while with the patient; I can type sentences, but not finish the all thing; I can’t either type sentences when it is a challenging session when the patient is disclosing important information about themselves, I feel that they really eye contact and therapist body language disposition to hear them. This is my main struggle.
Mar 23, 2023 @ 10:41:48
Hi Lexi,
It sounds like you’ve been really thoughtful about your use of self-disclosure. I think some professionals may use self-disclosure in a way that serves them more than the client. It sounds like in your case, you’re considering the needs of the population you work with, taking into account how it might be hard to trust and open up to a new counselor. Since you’re making choices to self-disclose based on what will be most helpful for the client, I’m sure that they often benefit from that! Helping our clients to understand we’re human too can go a long way in building that relationship.
Mar 22, 2023 @ 14:39:06
My biggest concern ethically is my social media presence. I run a small business so I post a lot of content. None of it is super personal or inappropriate, but I do worry about how accessible my posts are to my clients. I think I will probably end up hiring someone to make sure that my accounts are privatized.
I think that many other providers, especially those who grew up tethered to social media probably have trouble with this as well. Additionally, like we have spoken about previously, some professionals may not be up to date on treatment modalities and best practices.
The task that I find the least enjoyable is documentation. It is just time consuming and tedious. I think that as time goes on and I become more comfortable somewhere it will be easier for me. But as of right now, I find myself scheduling time to catch up on notes.
Mar 23, 2023 @ 10:21:29
Lindsay,
You bring up great points about social media presence that I wouldn’t have considered on my own. I can imagine having a small business makes it difficult to stay off social media or stay semi-hidden from people finding your socials. It’s good that your business is definitely ‘appropriate’ even if a client did find it.
Mar 22, 2023 @ 15:26:44
Lexi –
Your point on self-disclosure is so interesting. It is helpful in getting client’s to see you more as a person/human-being who is trustworthy, if you don’t just seem like a therapy robot behind a desk somewhere. But I often wonder, too – some things I just do not mind sharing, particularly because my clients are mostly kids – after a session, I’ll be like… “Was that the best thing to share with them? Should I have kept it to myself?” The good thing is so far it hasn’t been anything huge – mostly kids wondering how old I am compared to their parents (lol) but it’s not crazy to think someone will ask me something bigger at some point. (I saw a post asking therapists – how do you respond if a client asks you if you believe in God and wow… I needed to take a minute!)
To your point about documentation – my thing is always I don’t mind doing my job if it’s purposeful, but to spend that much time writing something that you know is never looked at again is incredibly frustrating. I’d imagine that it also can add to burn-out, as well!
The experience of looking back on a note and thinking “Well I probably should’ve included X,Y, Z because in hindsight it was pretty important” has also come up with me too. But I try to remind myself I can always add it to a future note. (Although this may not be the case with you if notes have to be kept super short!)
Thanks!
– Katie
Mar 22, 2023 @ 20:14:06
1. I think one ethical practice that may be challenging to uphold is only practicing in your area of expertise. Being in the helping profession, individuals may have good intentions when helping others but can have the opposite effect if going beyond their area of expertise. In terms of modality, when I first started my internship, my supervisor gave me a referral for an adult couple which I didn’t feel comfortable taking. I hadn’t worked with adults, let alone a couple. I think it is not only important to recognize your area of competence but also have the ability to let others know when something is out of you scope of competence.
2. I have found documentation to be the least enjoyable duty. I tend to put it off which then leads to a build up of progress notes to finish. I know it would be beneficial to do them right after each sessions but I’ll usually have a few back to back clients, with the last one ending at the same time the office closes. At that point, I just want to leave and go home and tell myself I’ll finish them when I get home, which rarely actually happens.
Mar 23, 2023 @ 10:46:37
Hi Giana,
I agree that it can feel tempting in a helping profession to want to help clients with whatever issues they are bringing to the table. However, as you pointed out, that can lead to unethical practice if we’re taking on issues that go beyond our training. I am always excited about an opportunity to learn and grow my skills, so I’ll often look into the evidence base when working with a client who has a presentation I’m not very familiar with. I’ve found that supervision has been invaluable in deciding whether that’s an area where I can try to rise to the challenge, or whether it’s something that requires a higher or more specialized level of treatment.
Mar 22, 2023 @ 21:53:05
1) Based on Table 2.2, I think the best ethical practice that is the most challenging for me to uphold pertains to only practicing in my area of expertise. I feel like I have already been very aware of this during my internship so far, especially with respect to addressing trauma and eating disorders, as these are things we are not able to address in a partial hospital level of care anyway. I think as a new professional it may be difficult for me to identify what is necessarily within my area of expertise currently and what are areas I overall need to learn a lot more about (e.g., treating eating disorders). I also think my imposter syndrome may tie into this as well, as I may doubt my abilities to treat someone and may initially feel something is outside of my area of expertise when it actually may not be. However, I think this will be something that I’ll be very aware of as a growing professional and will ensure to receive appropriate training in different areas to expand my clinical competence and will ensure to refer out when clinically appropriate and necessary.
2) The main required duty beyond therapy that I find least enjoyable is case management. Luckily during my internship so far I’ve been involved in little to no case management. The only extent to which I’ve been involved in it is simply discussing with clients what resources they may need or are interested in with respect to aftercare from our program, and then I communicate this to our discharge planner who actually finds these resources. After hearing about others’ experiences with pretty extensive case management at their internships I feel really lucky to not have this as a huge responsibility on my end and am grateful for the discharge planner and how easy it is to work with them when treating a client and planning for aftercare. Other than case management, I also don’t necessarily enjoy having to coordinate care with other providers and parents/family. I completely understand the importance of doing this and especially with family how important it is that they’re involved in treatment, especially at a PHP level, however I find that it takes up a lot of my time alongside the documentation for such calls, and can often be like playing phone tag with both providers and parents/family members.
Mar 22, 2023 @ 22:19:15
Hi Valerie,
Thank you for your insight and point of view about case management. I think most people do not enjoy the case management aspect of this work. I have said it before, but it’s something that doesn’t bother me too much and I don’t mind doing it. I know most people have had a bigger caseload than me, so I am sure that plays a role in their feelings toward case management as they have less time. I’m glad to hear though that there is someone at your agency that is in charge of most of the case management. I feel like that is super helpful so you can really focus on helping clients refine skills and tools they will need following discharge rather than spending an absurd amount of time playing phone tag!
Mar 22, 2023 @ 22:07:12
1. When looking at the table for best ethical practices, I can imagine that mental health professionals might struggle with practicing in their realm of expertise. As individuals in a helping profession, we want to help as many people as we can. However, it is important to keep in mind training and what clients and specialties we are prepared to work with. I can see myself doing this and will have to be mindful of it in the future. Additionally, the table pointed out how keeping up with new literature and research falls into this category. I feel like as a busy clinician it can be hard to take the time to delve into research and spend the time learning new skills or techniques, so it might get neglected. However, it is important that this is done to maintain competency and that other ethical guidelines like “do no harm” are upheld.
2. The thing that I find the least enjoyable right now is completing reassessments and updates to treatment plans. For in-home therapy, these have to be done more often and sometimes it just feels like I am writing the same things over and over because progress isn’t happening that fast. Also, for the care management REACH program at Family Continuity, re-assessments are done every 60 days and I feel like I’m asking the clients the same questions that I just asked them. Doing these re-assessments and updates feels very time-consuming and tedious, although I understand that they need to be completed to track progress and for medical necessity. Overall, though, I don’t mind the other aspects of paperwork like writing progress notes, doing initial assessments, and writing case formulations and treatment plans. However, I feel like once I have a full caseload, this might change as there will be less time to get these things completed.
Mar 22, 2023 @ 22:32:08
1. I think that for me one of the ethical challenges I have had to deal with is to do with protecting confidentiality. I think that there is so much more gray area when working with kids and adolescents about what you can and cannot disclose with the caregivers. Additionally, you are working with a variety of different systems, including the school, physicians, mentors, etc., and have to be very careful with what we can and cannot share. Additionally, I think thorough documentation can also be challenging since we are so limited by time, memory, and notetaking.
2. I think keeping up with the documentation peace has been the most challenging, and I’ve had a hard time staying on top of it as an intern. Though, I expect to do better once I am working full-time–hopefully!
Mar 23, 2023 @ 10:16:16
Pawel,
I think you bring up many important points and I can relate to a lot of it. I can see why working with children would make confidentiality a gray area because you’re working with in so many systems. I’ve had similar experiences with substance use, because many clients are involved with the legal system, attached to other programs, or have limited releases for many family members. It can be hard but it’s so important to stay stringent in those practices.
Mar 23, 2023 @ 10:32:35
Hi Pawl,
It seems that most of us think keeping up documentation is one of the most unpleasant tasks to do. In my internship, Clinical Supervisors are skilled in doing it immediately, and they pass a long notes the same day to 8 or 7 people they have seen. These are also short sessions, but still, I admired the talent of doing it. Unfortunately, I did not receive typing classes at school and have taken online exercises to speed up my typing. I am also trying to be more confident with my second language.
Mar 23, 2023 @ 08:48:22
1. I think the most challenging ethical practice to uphold for myself and many other professionals is self-disclosure. In my current work, I have clients ask a lot of in depth/personal questions. Sometimes I struggle with how to respond and saying no when I’m uncomfortable with a question. For example, many clients will ask about my experience with substance use or if I’ve struggled personally with addiction. I’ve had others ask if I can relate to a trauma they’re sharing which is uncomfortable because either answer could be damaging- if I say yes, that could cross an ethical line and if I say no the client may feel like I don’t understand or can’t sympathize. There’s a very fine line to walk with self-disclosure and it can be a learned skill. I think I’ll grow more comfortable with it as time goes on.
2. The duties beyond therapy that I find the most frustrating/least enjoyable is clinical note taking and documentation. I know it’s incredibly important and necessary but I don’t enjoy case management work, specifically documenting. It’s not difficult but it can be frustrating to have to go back to after meeting with clients all day or having a hundred other things to do.
Mar 23, 2023 @ 17:08:52
Hi Frayah,
I also find it difficult to self-disclose with clients, especially when they ask something about my past experiences. I typically only try to use self-disclosure when it involves using interventions and evidenced-based practices, especially when I find it to be effective.
I also relate to the endless amount of paperwork. It can be overwhelming, and I would rather look to the future rather than remember specifically what we talked about in session. I am working towards staying more on top of it, but it can be a challenge.
Mar 25, 2023 @ 12:38:05
Hi Frayah,
I agree that self-disclosure can be a very challenging ethical practice for many professionals to uphold. Like you pointed out, there is a fine line with when to self-disclose with clients. I think it is definitely a challenge that requires continuous self-awareness when working with clients. When meeting with clients, its important to be aware of similar experiences but to recognize when it is important to self-disclose only when it will be beneficial for the client.
Mar 23, 2023 @ 10:10:26
Based on Table 2.2 Upfront and clear about informed consent, protecting confidentiality was a struggle during my internship. Be very clear about the limits of confidentiality, including mandatory reporting and rules in the program and during the session. During my short experience at Spectrum, in the beginning, I did not realize the importance of confidentiality (because intake has already been conducted for clinicians) until I fell into a few situations that made me realize that always in the first session with your client, explain to them the limits of confidentiality and being a mandated reporter is fundamental. I have had situations such as; a high-risk patient consuming fentanyl at home and at the same time being the caregiver of her grandchild or a patient who lapsed and ended up with someone in his apartment who recently shot his neighbor or I had another patient who answered the phone during the therapy session and based on the conversation with his friend, It was easier to assume that he was selling fentanyl in front of his therapist. These and similar situations were discussed and brought to my supervisor, making plans to address them. Then, I learned that for every new patient in my caseload, it is fundamental to talk about the limits of confidentiality; then, they will be informed about what they can disclose and do within the Outpatient Clinic Center.
The administration management part is difficult to handle; I think that to provide a balance, I have to change the way to write my notes to make sure that it does not take more than 10 or 15 minutes because of the second language I tend to review it a few times that this is time-consuming so, I am learning to be more confident and submit it for approval. Also, productivity and compliance with the quarterly assessments are challenging if you want to focus on providing clinical interventions to your patients.
Mar 23, 2023 @ 16:00:41
Hi Lina,
I think that you bring up such a good point about from the jump we should make things clear about the limits of confidentiality, so that there are no surprises later on, and also so that we can protect our clients at the same time.
Mar 23, 2023 @ 20:52:13
Hello Lina,
You made great points in your post. I agree that confidentiality is challenging as during internship since we do not complete the patient intake and we often expect the patients to know these guidelines. I have found that at times I needed to revise confidentiality boundaries with my patients. Also, I agree with your point about quarterly assessments as they are challenging to maintain compliance due to other obligations.
Mar 23, 2023 @ 10:33:22
I think that for other professionals, utilizing evidence-based practices may be the most difficult to uphold. Through my practicum and internship experiences, I was able to work with over 20 different clinicians/counselors and see their different approaches to therapy. Although this gave me a lot of knowledge, it also helped me to see that it’s common for mental health professionals to focus on their own personal style/approach rather than what is evidence-based. I think our program has given us a unique opportunity to learn about evidence-based approaches and appreciate their importance. For myself, I think the social media aspect can be the most difficult. I remember working in residential and having the youths create fake accounts, pretending to be my coworkers to try to add staff on social media. When client’s really want to dig up information on us, they can be pretty persistent. Making sure that all of my information is private isn’t too difficult, but I do feel the most frustrated having to take those steps.
I think thorough documentation may be the least enjoyable duty. Personally, I enjoy writing shift notes and find keeping a record of what was discussed and what progress was made as very important. However, based on my summer practicum and what I’ve heard from classmates, the additional paperwork that agencies require can be cumbersome and sometimes interfere with spending time actually working with the client on their goals. I expect that starting out I will likely be required to do a lot of that paperwork, and am least looking forward to that part of the job.
Mar 23, 2023 @ 17:02:41
Hi Christina,
I am sorry you went through that on social media. Unfortunately, in today’s society, there are many ways for people to creatively hack or view our accounts. I am glad you are being safe by keeping things private!
Yeah, I also said that paperwork can be frustrating. It can be hard to keep up with the endless amount of progress notes, comprehensive assessments, and individualized action plans. However, I also find it enjoyable to report the progress clients are making.
Mar 25, 2023 @ 18:33:04
Hello Christina,
I enjoyed reading your post. I agree with your point about social media as our social accounts can be found easily so taking percussion is needed which is a bit annoying. I also agree that I expect more paperwork once I start my job and definitely it is not something I am looking to do.
Mar 23, 2023 @ 14:22:37
I think that the best ethical practice that is most challenging for professionals to uphold is both practicing in their realm/scope of expertise and maintaining a professional social media presence. I think there’s a lot of practicing clinicians who will take whatever client despite their presenting problems for the sake of having clients on their caseload. Some professionals may not set a clear limit on the types of presenting problems that they are most effective working with and may consider themselves to be a “jack of all trades”. While it is not impossible to have a foundational understanding of all aspects of mental health, I think that “being an expert” in every disorder is a stretch. Similarly, in the technological age that we are current living in, it may be difficult for professionals to maintain a positive social media presence. While this is in part due to the “junk” that floods our feeds, I personally believe this is also due to the toxicity that is social media in general. Some individuals also have the desire / think it’s necessary to share every aspect of their lives over social media regardless of its content – and while it is fun to share our fun weekend at the brewery with our friends, or the crazy lake weekend we had, it is also important to consider the nature of the content – something that is overlooked.
Personally, I think the least enjoyable duty beyond therapy would have to be documentation. While I do not necessarily mind doing notes as I have been able to get them done within 5 mins after my client leaves, I still think it can be mundane and time consuming – especially when your caseload starts to pick up. Likewise, I personally don’t enjoy having to do things like a CANS assessment. Don’t get me wrong, I love assessments and think that they are incredibly necessary. BUT I am sick of doing CANS assessments because they are so time consuming and I tend to lose my focus when trying to complete them – which of course makes it take even longer.
Mar 23, 2023 @ 18:29:07
Hi Francesca,
I think you raise a very good point about social media use and that professionals don’t always realize the impression their posts may give off to other people. I think that setting your profiles on private is a must for people working in our field. Even when set on private, I think that we should even be mindful of the content we post because we may have colleagues and other professionals that may follow our accounts.
Mar 25, 2023 @ 12:19:55
Hi Francesca,
I agree with your point that being an expert in every disorder seems unrealistic. It is important for us to recognize when something is out of our area of expertise. With this, when we can acknowledge when something is out of our scope of competence, we owe it to our clients to refer them to someone who is better trained and can provide the proper care they need. This goes hand in hand with the ethical guideline of “do no harm,” as if we are seeing clients who’s presenting problem is out of our scope of expertise we can do more harm than good to the client.
Mar 23, 2023 @ 16:56:46
(1) I find that maintaining confidentiality is difficult under certain circumstance, and I will explain this in two examples. I had a 40-years-old client previously who was referred for psychiatry and therapy by his mother. When we began the intake, I had him sign an authorization for release forms so his mother could be informed of his treatment plan. As time went on, I learned that the son’s assessed needs were different from his mother’s, and he did not want her to know this. Whenever I would call to remind the client of his appointments, his mother would respond instead, and she would ask me what would be appropriate for the session. I had to remind the mother that she was not his legal guardian, and while she wanted him to receive therapy, he only wanted to receive psychiatry, and I had a duty to uphold his assessed needs.
I also have a client is involved with DCF, and I also had him sign an authorization for release form for DCF. He reported that they would be in contact with me about his progress in therapy. When I consulted with my supervisor, she informed me to be general and vague with my answers and protect my client’s privacy. I found it difficult to share broad information about my client’s progress and treatment plan without going into detail, and it seemed that the DCF social worker was fishing for more information than I felt comfortable disclosing. On my end, I felt that the phone call went well, but I believe it may have caused some confusion on the client’s end. Keeping confidentiality is important and makes sense written on paper, but it can be challenging to uphold under certain circumstances.
(2) I find the paperwork to be frustrating at times. This week I had 12 client appointments, and now I must fill out 12 different Progress Notes, not to mention finish each Comprehensive Assessment and Individualized Action Plan. At times, I can keep up with the workload, while other times I am envious of my colleagues who have the same number of clients but work 40 hours a week instead of 20. However, while this is frustrating at times, I am enjoying this part of the experience. I enjoy the freedom my supervisor gives me in documentation. I am able to effective use the interventions and treatment plans that I see fit for my clients. My supervisor may return a few notes back here and there so that I can improve my language or insert the correct interventions, but other than that, I am please to be able to complete the plans. I also am satisfied when I am able to either keep up with my workflow or catch up by the end of the week.