Course Overview
Private practice continues to be a preferred destination for many licensed mental health professionals in the United States (Barnett et al., 2014). However, graduate training programs do not comprehensively prepare practitioners to address the complex interplay of regulatory, legal, and ethical issues that arise in private practice settings (Faye et al., 2021). Free legal counsel is not a given for solo or group practices, and as a result many clinicians must respond to these complexities in a context of professional isolation. Unfortunately, many continuing education programs on professional ethics focus on the basics of ethical decision making with a tired review of confidentiality, suicide assessment and intervention, dual roles, boundaries, and informed consent. In this program, participants will explore the ethical and legal implications of Incident to billing, clinician-initiated termination of care (Swift, 2017), role shifts, out-of-session client communication (Faye, 2021), recommending emotional support animals for current clients (Younggren 2017), and balancing confidentiality rights between minors and parents/guardians in treatment (Shumaker & Medoff, 2013). This presentation will be inclusive to all professional identities and focus on helping providers to anticipate and manage these unique ethical challenges in a way that elevates client care and insulates your practice from professional liability. Participants will leave this program with specific strategies that are consonant with their own code of ethics, practice setting, and professional values.
Learning Objectives
- Participants will summarize 3 best practice standards for managing ethical dilemmas in private practice settings.
- Participants will identify 5 liability management practices that enhance clinical effectiveness.
- Participants will evaluate their current ethical decision-making process for navigating consent and confidentiality with minors, dual roles, out-of-session client communication, billing practices, and clinician-initiated termination of care.
Course Outline
| Module | Topic |
|---|---|
| SECTION 1 | Topic Introduction and Course Overview (Conflict of Interest, learning objectives, limitations, & statement of problem) (5 min) |
| SECTION 2 | Consent, Custody & Confidentiality with Q&A (35 min) |
| SECTION 3 | Dual Relationships: Service Provider vs. Evaluator role with Q&A (25 min)
|
| SECTION 4 | Boundaries and Out-of-Therapy Communication (15 min)
Billing Practices (20 min)
Clinician-Initiated Termination of Care (20 min)
|
Instructor Bio
Dr. Impellizzeri also known as “Dr. J.” is the first Certified Gottman Couple Therapist (CGT) in Western Pennsylvania. CGT’s have specialized training in a research-based approach to treating distressed couple relationships. Dr. J also has extensive training in Emotion Focused Couples Therapy (EFT) which is a complimentary evidence-based approach to couples therapy. In 2017, Dr. J launched the Center for Marriage and Family at CBI which focuses on providing high-quality relationship-oriented therapy that is research-informed, client directed, and peppered with a healthy dose of compassion. Dr. J specializes in working with couples who are struggling with just about anything under the sun including infidelity, gridlocked conflict, pre-marital enrichment, grief & loss issues, trauma, faith conflicts, estranged relationships, and parenting differences. While he continues to provide counseling services in a traditional 50-minute format, he also offers marathon therapy for couples who are in need of more acute care. He has extensive counseling experience in community based, outpatient, and group private practice settings. For the past 12 years, Dr. J has served as a Counseling Professor and Director of the Marriage and Family Counseling Program at Geneva College. He taught a variety of graduate-level courses including Faith-Based Counseling, Marriage and Family Counseling, Professional Ethics, and Psychopathology. He currently services as the Chief Clinical Officer at Cognitive Behavior Institute and regularly runs virtual consultation groups for clinicians interested in developing competencies as a couple therapist.
Course Bibliography
American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author.
Barnett, J. E., Zimmerman, J., & Walfish. S. (2014). The ethics of private practice: A practical guide for mental health clinicians. Oxford University Press.
Barnett, J. E., & Johnson, W. B. (2015). Ethics desk reference for counselors. (2nd ed.). Alexandria, VA: American Counseling Association.
Butler, P. W., & Middleman, A. B. (2018). Protecting adolescent confidentiality: A response to one state’s “Parents Bill of Rights”. Journal of Adolescent Health, 63, 357-359. https://doi.org/10.1016/j.jadohealth.2018.03.01
Duncan, R. E., Hall, A. C., & Knowles, A. (2015). Ethical dilemmas of confidentiality with adolescent clients: Case studies from psychologists. Ethics & Behavior, 25(3), 197-221. https://doi.org/10.1080/10508422.2014.923314
English, A. (2021). Adolescent relationship abuse: Challenges in Confidentiality, disclosure, and protection. Journal of Adolescent Health, 69(2), 181-182. https://doi.org/10.1016/j.jadohealth.2021.04.027
Faye M., Sanders, J., Fantus, S. et al. (2021). #socialwork: Informal use of information and communication technology in social work. Clinical Social Work, 49, 85–99 https://doi.org/10.1007/s10615-019-00729-9
Greenberg, S. A. & Shuman, D. W. (1997). Irreconcilable conflict between therapeutic and forensic roles. Professional Psychology: Research and Practice, 28(1), 50-57. https://doi.org/10.1037/0735-7028.1.50
Hames, J. L., Bell, D. J., Perez-Lima, L. M., Holm-Denoma, J. M., Rooney, T., Charles, N. E., Thompson, S. M., Mehlenbeck, R. S., Tawfik, S. H., Fondacaro, K. M., Simmons, K. T., & Hoersting, R. C. (2020). Navigating uncharted waters: Considerations for training clinics in the rapid transition to telepsychology and telesupervision during COVID-19. Journal of Psychotherapy Integration, 30(2), 348–365. https://doi.org/10.1037/int0000224
Herlihy, B., & Corey, G. (2015). ACA ethical standards casebook. (7th ed.). Alexandria, VA: American Counseling Association.
MacMullin, K., Jerry, P., & Cook, K. (2020). Psychotherapist experiences with telepsychotherapy: Pre COVID-19 lessons for a post COVID-19 world. Journal of Psychotherapy Integration, 30(2), 248-264. http://dx.doi.org/10.1037/int0000213
McNary, A. (2014). Consent to treatment of minors. Innovations in Clinical Neuroscience. 11(3-4), 43-45.
Piselli, A., Halgin, R. P., & Macewan, G. H. (2011). What went wrong? Therapists’ reflections on their role in premature termination. Psychotherapy Research, 21(4), 400-415. http://dx.doi.org/10.1080/10503307.2011.573819
Shapiro, M. (2018). Pediatric depression: When does parental refusal for treatment constitute medical neglect? Journal of the American Academy of Child & Adolescent Psychiatry, 57(6), 363-365. https://doi.org/10.1016/j.jaac.2018.02.01
Shumaker, D., & Medoff, D. (2013). Ethical and legal considerations when obtaining informed consent for treating minors of high-conflict divorced or separated parents. The Family Journal: Counseling and Therapy for Couples and Families. 21(3), 318-327. https://doi.org/10.1177/1066480713478786
Sude. M. (2013). Text messaging and private practice: Ethical challenges and guidelines for developing personal best practices. Journal of Mental Health Counseling, 35(3), 211-227. https://doi.org/10.17744/mehc.35.3.q37l2236up62l713
Swift, J. K., Greenberg, R. P., Tompkins, K. A., & Parkin, S. R. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy, 54(1), 47-57. http://dx.doi.org/10.1037/pst0000104
Vincent, C., Barnett, M., Killpack, L., Sehgal, A., & Swinden, P. (2017). Advancing Telecommunication Technology and its Impact on Psychotherapy in Private Practice. Clinical Practice & Technological Change, 33(1), 63-76. https://doi.org/10.1111/bjp.12267
Weever, C. M., & Meyer, R. G. (2019). Law and mental health: A case-based approach. (2nd ed.). New York: Guilford Press.
Wheeler, A. M., & Bertram, B. (2015). The counselor and the law: A guide to legal and ethical practice. (7th ed.). Alexandria, VA: American Counseling Association.
Wilcoxon S. A., Remley, T. P., & Gladding, S. T. (2012). Ethical, legal, and professional issues in the practice of marriage and family therapy. (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Wilkinson, T., Smith, D., & Wimberly, R. (2019). Trends in ethical complaints leading to professional counseling licensing boards disciplinary actions. Journal of Counseling & Development. 97, 98 -104. https://doi.org/10.1002/jcad.12239
Younggren, J. N., Boisvert, J. A., & Boness, C. L. (2016). Examining emotional support animals and role conflicts in professional psychology. Professional Psychology: Research and Practice, 47(4), 255–260. https://doi.org/10.1037/pro0000083
Approvals
Cognitive Behavior Institute, #1771, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 06/30/2022-06/30/2025. Social workers completing this course receive 2 ethics continuing education credits.
Cognitive Behavior Institute, LLC is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0098 and the State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0646 and the State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0216.
A New York State licensee is responsible for complying with New York State laws, rules and regulations.
https://www.op.nysed.gov/professions/psychology/laws-rules-regulations.
Cognitive Behavior Institute has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7117. Programs that do not qualify for NBCC credit are clearly identified. Cognitive Behavior Institute is solely responsible for all aspects of the programs.
Cognitive Behavior Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Cognitive Behavior Institute maintains responsibility for content of this program.
Social workers, marriage and family therapists, and professional counselors in Pennsylvania can receive continuing education from providers approved by the American Psychological Association. Since CBI is approved by the American Psychological Association to sponsor continuing education, licensed social workers, licensed marriage and family therapists, and licensed professional counselors in Pennsylvania will be able to fulfill their continuing education requirements by attending CBI continuing education programs. For professionals outside the state of Pennsylvania, you must confirm with your specific State Board that APA approved CE's are accepted towards your licensure requirements. The Association of Social Work Boards (ASWB) has a process for approving individual programs or providers for continuing education through their Approved Continuing Education (ACE) program. ACE approved providers and individual courses approved by ASWB are not accepted by every state and regulatory board for continuing education credits for social workers. Every US state other than New York accepts ACE approval for social workers in some capacity: New Jersey only accepts individually approved courses for social workers, rather than courses from approved providers. The West Virginia board requires board approval for live courses, but accepts ASWB ACE approval for other courses for social workers. For more information, please see https://www.aswb.org/ace/ace-jurisdiction-map/. Whether or not boards accept ASWB ACE approved continuing education for other professionals such as licensed professional counselors or licensed marriage and family therapists varies by jurisdiction. To determine if a course can be accepted by your licensing board, please review your board’s regulations or contact them. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.