Topics 7 & 8: Ethical Considerations and Non-Therapy Duties {by 6/23}

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 6/23.  Post your two replies no later than 6/25.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

18 Comments (+add yours?)

  1. Monica Teeven
    Jun 17, 2021 @ 16:33:46

    1. The best ethical practice that I think is the most challenging to uphold is the ethical practice of only practice in area of expertise. Before the pandemic, I think I would have thought this ethical practice would not be challenging for myself or other individuals in the field. However, due to the high demand for mental health services related to Covid-19, I think mental health professionals would be more willing to take on a client that has mental health issues in which they are not an expert. This is because if the mental health professional does not accept this client, what is the chance that this client will find another mental health professional to take them on within the next month? The waitlist for finding a therapist right now is horrific. For individuals who have moderate to severe mental health issues, is it better to receive therapy from a clinician who is not an expert in their mental health disorder, or to wait for months for a clinician who does expertise in their mental health disorder?

    2. One required duty beyond therapy that I found frustrating at my internship is when I would be assigned to update treatment plans for individuals who were receiving methadone treatment, but had no assigned clinician. This frustrated me on several occasions because the only reason I was updating these treatment plans is because it makes the organization look better. These treatment plans were being updated because the organization were being looked at by the higher-ups and were being reviewed by the state. Many of these clients asked me to be their clinician even though I already had over 20 clients. I eventually took on some of these clients because I knew they would greatly benefit from having an assigned clinician even if it was for less than 4 months. In addition, these individuals wanted therapy whereas some individuals at the methadone treatment center did not, including some of the clients who were already on my caseload. I did not understand the point of updating these treatment plans because the likelihood that any clinician would work on these treatment goals with these individuals within the next 3 to 6 months was nearly zero. This task I was assigned to do was not for the benefit of the clients, but was for the benefit of the organization.

    Reply

    • Melanie Sergel
      Jun 22, 2021 @ 16:28:00

      Hi Monica! I did not identify only practicing in area of expertise as the most challenging to uphold but I can agree that this may be something I am challenged to uphold. I think in the future I will have clients that have mental health issues that I will not be an expert in. Like you said, waitlists can be long and these individuals are waiting for treatment. You questioned if it may be better to receive therapy from a clinician who is not an expert in the client’s mental health disorder than waiting months for someone who is and I think it can be viewed as more important for them to be seen rather than waiting. I also wonder if they can be in treatment with someone who is not an expert until referrals for an expert is open. It is important that if we have a client with mental health issues out of our expertise that we ensure we are using supervision and literature to provide the best treatment for these clients.

      Reply

    • Madison Armstrong
      Jun 24, 2021 @ 19:57:30

      Hi Monica!
      I think that you have also identified an ethical practice, practicing only in your area of expertise, that can be challenging to uphold. This ethical practice can definitely be tricky. As Dr. V spoke on in class, I do not feel like an expert in any one disorder or population quite yet, and I am doubtful I will for some time. I think that taking certain trainings or classes on different populations or disorders is one way to gain that expertise or knowledge of how to treat certain clients. Your question at the end of your first point is a great one, as I believe that it may be more beneficial in some cases for someone to have a therapist to talk to while they are waiting for someone with more expertise in their presenting problems. With the waiting lists being so long, I feel like some people may not even get to be seen or by the time they are able to be seen their problems may escalate. I think in certain cases this may be okay as long as the therapist is honest about their expertise with the client in that area and continues to learn and utilize evidence-based practices.

      Reply

  2. Jenna Nikolopoulos
    Jun 21, 2021 @ 12:33:21

    1. The best ethical practice I think is the most challenging to uphold for myself is excessive or inappropriate self-disclosure. I think this challenging for myself as I want my clients to get to know me on a basic level to help build rapport, comfortability, and trust, but I also know that there are some things about me that my clients don’t need to know because they aren’t important and don’t pertain to the nature of our relationship. During my internship, I would share some things about myself, particularly if it related to the conversation I was having with my client, to help my clients see that I could relate to the conversation we were having and what they were feeling. However, at the same time, there would be times where I would wonder if I was sharing too much or if what I did share was truly necessary. I think my clients appreciated when I shared information about myself, but I also didn’t want to give the wrong impression about the boundaries between my role as their clinician and their role as my clients. Also, there were times when my clients would ask questions about myself because they were curious as to who I was as a person since I was new to them and much younger than they were. I would give them a basic response to their question and then try to redirect the conversation back to them or what we were previously talking about. This is something that I also discussed with my supervisor in terms of what is and is not okay to share with my clients and how do I go about sharing information about myself without sharing too much. He gave me good advice as to how to go about appropriately sharing and how to respond if asked a question that I don’t feel comfortable answering. In terms of looking at this practice for other professionals, overtime, I think it is easier for professionals to set clear boundaries with their clients and know how to appropriately engage in self-disclosure . Since I am a new professional in the field, my future experiences will help me gain experience in area and how to navigate it in the future.

    2. One required duty beyond therapy that I find the least enjoyable, and sometimes frustrating, is the paperwork. Even though I only had 8 clients on my caseload during my internship, I had to complete all of my progress notes, yearly comprehensive assessments (which included a main assessment plus 9 other addendums) for clients that were and weren’t on my caseload, group progress notes for the group therapy I was part of, and notes that pertained to client meetings I had with my supervisor. All of this paperwork on top of the schoolwork I had to complete could be overwhelming at times. I know that in the future I won’t have to worry about any schoolwork, but when looking at all of the paperwork I had to complete on its own and the amount of time it took me to complete all of that paperwork, it was difficult for me to stay on top of it. Especially now that when I work for an agency my caseload will be significantly bigger, which will make the paperwork that much less enjoyable and potentially more frustrating as I try to find a good schedule and manner to complete all of my paperwork on time. Another required duty beyond therapy that I find the least enjoyable and frustrating are the case management duties for my clients. This is because these duties could take up a good amount of time away from my other clients or from my own personal time as I try to assist my clients in finding proper resources to help them get what they need/want. During my internship, there was one instance where I met with a client and they needed help filling out paperwork to renew their food stamps. I know nothing about the process to obtain or renew food stamps and it was very frustrating looking at the paperwork and trying to figure out how to help my client. I felt so useless. I tried calling multiple people in the agency and no one picked up the phone, which made me feel even more useless and frustrated. Even though it is something I will learn over time, right now, case management duties go beyond the scope of my skills; and I hope as I gain further experience in the field, I will be able to help my clients in other areas beyond just counseling.

    Reply

    • Melanie Sergel
      Jun 22, 2021 @ 15:51:07

      Hi Jenna! I also think that the most challenging ethical practice to uphold for myself is excessive or inappropriate self-disclosure. I can agree with you that this is challenging because we want our clients to get to know us but like you said, we want them to know us on a basic level because it helps build rapport, comfortability, and trust. I do think we can do these things without having the client knowing us but when working with adolescents some struggle to build that therapeutic relationship without knowing us on a basic level. I agree that I think our clients appreciate when we share information about ourselves, but we should also be very aware of what information we give them, especially with the point you made about our boundaries with our clients. I have had to redirect conversations many times when clients have asked personal questions, but I always try to ensure that this is not going to be perceived as rude towards the client. I agree that this is something that we will get better with when we gain more experience.

      Reply

    • Monica Teeven
      Jun 23, 2021 @ 13:17:16

      Hi Jenna! I can relate to you not enjoying case management duties for clients. I had an instance of trying to find a soup kitchen for my client who was homeless during our session since my client has not eaten in over 24 hours. What was even more infuriating is that a lot of the soup kitchens are only open for a short period of time, sometimes only a couple of days a week, so just trying to find one soup kitchen that was open was very difficult. In addition, knowing that my client will have to walk several miles to get to the soup kitchen was also frustrating since my client was already underweight and was very hungry. In your blog post, you mentioned all of the paperwork you had to do and it sounded like you did all of the paperwork like progress notes outside of the session time. Is that true? If so, I think that will be a huge transition for me if the place I work after graduating wants me to write progress notes after the session since at my internship, we were supposed to complete all paperwork during the session time.

      Reply

    • Shelby Piekarczyk
      Jun 25, 2021 @ 16:26:40

      Hi Jenna,

      I agree that self disclosure can be a very tricky topic and wondering when / if to share information. Especially when working with children and adolescents they can ask a lot of questions making keeping our personal information to ourselves challenging. I also find it hard that children and adolescents sometimes don’t understand a therapeutic relationship (As Madi said in class) so asking questions and trying to find out information about us is natural to them. However, this leaves us in a difficult spot because we are unsure what information is appropriate to share. I found myself in my internship second guessing myself and sometimes wondering if I should share information or not. I think with practice we will develop a better understanding of when to disclose information.

      Reply

  3. Melanie Sergel
    Jun 22, 2021 @ 12:46:54

    1. The best ethical practice that I think is the most challenging to uphold is excessive or inappropriate self-disclosure. I have found this to be challenging in the setting I have worked in the last several years. The reason I find this challenging within my setting is because the adolescents I work with are always so curious about our personal lives. These clients are constantly asking questions about you and want to know more about their staff… they are very nosy. It is hard because you do not just want to ignore their questions, but you have to remember that they do not need to know your information and that there are things that they definitely do not need to know about you. In my internship I really tried to avoid self-disclosure because it is not something I like to use, especially with the population I work with. For example, something as simple as them finding out you have dinner with you parents once a week can remind them that their family does want to see them etc. I think that this is something I will always have to monitor moving forward because you do not want your clients know too much about yourself because it affects the therapeutic relationship and also deters attention away from the client. Many professionals try to avoid self-disclosure, however, there are times that self-disclosure is appropriate. I will continue to discuss this with my supervisor to avoid inappropriate self-disclosure.

    2. One duty during my internship that I found the the least enjoyable, and sometimes frustrating, was completing the CANS. I found this to be frustrating because this was the only assessment that the program had and it was to be completed with the information from the DCF referral and the intake, which was completed by a caseworker. I understood why a CANS was used but it is time consuming, and I think that there are other assessments the program could have provided that would be more useful. Another duty that I found to not be enjoyable was team meetings with the ICC. In my own experience, I had ICC’s that would take up more time talking about things with other team members that had nothing to do with the client, whereas meetings with DCF would review important information and time was not wasted. At times, it felt more of a waste of time and you would know that they would take up all this unnecessary time for billing purposes.

    Reply

    • Monica Teeven
      Jun 23, 2021 @ 13:17:48

      Hi Mel! I agree it is sometimes hard to figure out how much self-disclosure is important. I do not believe a little self-disclosure is bad and honestly I think it can be very beneficial for a therapeutic relationship. For example, one of my clients told me once they were watching a documentary about serial killers and was blown away by how their minds worked. I asked if they had seen any of the Ted Bundy documentaries since I enjoy watching serial killer documentaries as well. In this case, I provided some self-disclosure. However, nothing too personal such as where I live. Providing a little self-disclosure once in a while is okay because it helps clients to realize we are humans too and have interests.

      Reply

    • Madison Armstrong
      Jun 24, 2021 @ 19:58:41

      Hi Mel!
      Also working with children and adolescents, I find it difficult to avoid self-disclosure because they will always ask us questions since they naturally want to get to know us as well. I do think that you make a great point about being careful about what we self-disclose because it could upset our clients or trigger and emotional reaction that wouldn’t have been triggered without our disclosures. I also found completing CANS assessments to not be enjoyable and frustrating. I found the CANS assessments to be very time consuming. At my agency we had to do the CANS on paper and then scan them in which made it more difficult/ time consuming to complete than using the virtual gateway. I think that the idea behind a CANS assessment is great but there are flaws as I agree there are other assessments that may be better.

      Reply

  4. Robert Salvucci
    Jun 22, 2021 @ 14:09:03

    1. I’ve found that I struggle with a mixture of only practicing in my area of expertise and selecting appropriate evidence-based interventions with new clients. When I started my practicum, I was both very eager to use CBT interventions but also hesitant as to how to appropriately implement them. I haven’t taken the programs course on substance abuse specifically, so I’ve done my best to integrate what I’ve learned from the program and on my own about behavior change and substance use. It isn’t always clear when is an appropriate time to introduce the model or interventions, depending on a client’s presenting concerns. Many of my clients are also court ordered or have switched from another therapist within the agency, which makes it more difficult at least initially to tie their treatment goals to the CBT model. I also find myself questioning how trained I need to be for it to be “adequate”. I have done a lot of reading on my own time about things like specific techniques for changing habits and improving well-being, but my formal training on those is limited. As I practice more, I’m finding myself become more comfortable and seeing the overlap and nuance in how evidence-based techniques can be used for different populations and diagnoses.

    2. The way in which we write treatment plans, particularly with groups has been frustrating, as well as the amount of paperwork that goes with intakes to the program. The treatment plans require a very specific wording and want each client’s first goal to be writing word for word verbatim. This makes it very difficult to fill out when we’re doing plans for groups, as each person needs to create and review their own plan and make sure the wording is correct. Each intake generally requires an additional 1.5 – 2 hours of typing up, signing, filling out, and re-checking forms with can be monotonous.

    Reply

    • Shelby Piekarczyk
      Jun 25, 2021 @ 16:29:38

      Hi Bobby,

      I agree that knowing and practicing in our area of expertise can be challenging. Being young professionals who are just developing themselves in the field this can be extra hard. I at points want to try and experience different areas but either quickly learn I am not interested or “good” at this area or that I may feel uncomfortable in certain areas. I think that once we learn more of what we like and areas that we excel in and enjoy this will become easier. I also agree that it takes time to understand when to maybe so no to clients and referring them to a different provider. As Dr.V said this would be the best ethical practice and ultimately what our clients deserve! Great post!

      Reply

  5. Shelby Piekarczyk
    Jun 23, 2021 @ 09:32:05

    1. The best ethical practice that I think would be the hardest to obtain is excessive or inappropriate self disclosure. I think this can be challenging because when you develop a great therapeutic rapport with your client at times, you can feel that they are your ‘friend’ or that you can tell them more information than is appropriate. As a new professional I think this line can be challenging and an area that I personally will really need to be aware of as my professional career develops. I also think at times, there are some clients who may push or want personal information. This can make the therapist feel that they must indulge in this conversation and self disclose to the client. However, like we learned in our program it is ok to self disclose to a certain extent if you feel that this will help the client in a positive way. If the self disclosure does not help the client then there is no reason for the clinician to disclose this information. I believe with practice and always being aware of this can help clinicians within their professional careers.

    2. The amount of paperwork that must be done for each client I found frustrating throughout my internship. As an intern I did not have as many clients as a seasoned clinician, this makes me nervous when I do become a professional myself. Clinicians in our field tend to be overworked and have a large caseload and because of this the amount of paperwork can be overwhelming. This also takes a profound amount of time to complete, leaving the clinician feeling drained. As a perfectionist I liked to complete my paperwork in full detail, probably at times writing too much. This was also frustrating to me because this would make doing paperwork even more stressful and time consuming.

    Reply

    • Jenna Nikolopoulos
      Jun 23, 2021 @ 18:33:32

      Hi Shelby! I totally understand where you’re coming from. I felt I had so much paperwork for my small caseload of clients as an intern and I am nervous to see what a large caseload of clients would look like. I also feel the need to provide full details when doing my paperwork, which can get very frustrating. I have been trying to remind myself that it is okay to be concise and still get all the necessary details in. However, it is hard to limit myself when I feel like I have so much to say!

      Reply

    • Robert Salvucci
      Jun 25, 2021 @ 15:25:38

      Hey Shelby!

      I also notice that as I get to know my clients more, it can feel odd not sharing much about myself and intentionally refraining from bringing a conversation towards shared interests or life experiences as I might in a different context. There is definitely a boundary to be struck in not being overly rigid while not making a session about yourself. I liked Dr. V.’s point about it being easier to start with reaching minimal self-disclosure and learning over time where exceptions may be appropriate.

      The idea of having about 3 times as many clients does seem daunting at times, as I worry about being able to keep up with all of the paperwork. This is definitely why it’s important to know what our limits are and keep up with self-care strategies and setting boundaries. As Madi mentioned, over time we’ll find more effective ways to manage quality with efficiency in paperwork.

      Reply

  6. Madison Armstrong
    Jun 23, 2021 @ 13:24:25

    1. I think that for myself, and other professionals excessive or inappropriate self-disclosure is one of the most challenging ethical practices to uphold. Working with children and adolescents, they will often ask personal questions. I believe this is mostly due to them not being able to comprehend the nature of a therapeutic relationship and the natural desire to want to get to know somebody that they are sharing much of their own personal information with. It can be difficult to navigate when it is appropriate to answer these questions and when/how not to. Sometimes a client may be asking a more personal question due to having a similar experience of their own. For this reason, I think that it is important to explore a client’s motivation for asking for disclosure. It’s important to consider if the self-disclosure will have positive or negative consequences on the client or if they are just curious and the disclosure is irrelevant to treatment.

    2. Beyond therapy, I find that the paperwork is the least enjoyable and sometimes frustrating task of being a therapist. When I first started my practicum, I was surprised by the amount of paperwork that needed to be completed for each client. Although, I was initially eager and excited to fill out this paperwork because I was learning the ins and outs of being a therapist, that excitement eventually wore off. I do still enjoy certain paperwork; however, I find that weekly progress notes are difficult to complete. I know that it is best to complete these after each session, but I do find myself falling behind on completing these because I find that the 10 minutes, I have between sessions is helpful for me to use as a time to either eat a quick snack, drink some water, and/or orient myself for the next session. It becomes frustrating when I fall behind on progress notes and must complete several in a row. I think that because I am new to the role these things still take me much thought, effort, and time to get done, but I do believe that as I continue working, I will be able to do these quicker and it will come more naturally to me.

    Reply

    • Jenna Nikolopoulos
      Jun 23, 2021 @ 18:48:27

      Hi Madi! I totally agree with what you said about self-disclosure. I think it can be especially hard when working with children and adolescents to limit self-disclosure if they are asking personal questions because. We want to seem relatable to adolescent clients, which can help gain their trust. However, we need identify the line between being their therapist and being their friend. We want to have a friendly relationship with them, but as their therapist, we are not really their friend. I think it’s a good idea to explore the client’s motivation for asking for disclosure to understand why they want to know certain information and how does that relate to the work we’re doing together. Setting clear boundaries at the beginning of treatment is best to ensure each party knows their role in the relationship.

      Reply

    • Robert Salvucci
      Jun 25, 2021 @ 15:17:28

      Hey Madi!

      I think you bring up an important point about children and adolescents not understanding the nature of a therapeutic relationship. I think this is also true for most adults, unless they have had a lot of exposure to therapy or have training in it. Relationships generally form through reciprocal sharing of likes, interests, values, and increasing vulnerability over time. Therapy is somewhat unique in that, as therapists we engage in a minimal amount of self – disclosure. This can represent a shift from what many of our clients are used too. Hopefully, it can also represent a positive experience in which the time spent with us is characterized by a focus on their own concerns and goals in a compassionate setting.

      Paperwork was also somewhat exciting as well as overwhelming for me when I started at my internship. A lot of stress can come from anticipating the paperwork load that I know I’ll have in between sessions. As you mentioned I think that over time we become more efficient and effective in doing paperwork and managing our time.

      Reply

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Adam M. Volungis, PhD, LMHC

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