Ethics Workshop
Creativity and Madness
Santa Fe
29-30 July 2014
THE MERGER OF
PROFESSIONAL ETHICS, BEST PRACTICES
AND THE LAW IN PSYCHOTHERAPY
John R. Graham, MD FRCPC FAPA
Renee Leff, JD LMFT
Introduction
When patient and therapist come together, multiple factors
influence treatment outcomes. External forcing factors that seem
beyond the control of the therapist include the state of the economy,
professional licensing requirements, federal and state law, policies of
health care organizations, insurance criteria, administrative policies,
government regulations and sociocultural beliefs on what constitutes
health and sickness.
In sharp contrast, there are choices and responsibilities within the
clinical interaction between patient and therapist behind the closed door
of the therapeutic alliance.
This workshop is therapist-focused, designed to stimulate the
inquiry process with applications to ongoing clinical work behind the
office door. Participants will learn how to recognize and resolve legal
and ethical dilemmas, as well as clinical techniques of probable
application to their work. Additionally, they will review their clinical
practices with user-friendly guidelines, improving care and protecting
against risk. Definitions of improved and informed clinical practices in
line with the highest ethical standards of care and the law will be
refreshed and restructured as your professional therapist
responsibilities.
The patient-focused inquiry raises many questions: What is to be
treated; what is the optimal match of needs, resources and methods;
what forces for self-responsibility shape outcomes; how can the
therapist create a setting fostering optimal adaptive capacity and
autonomy of the person; and when is there enough treatment to sustain
healthy development.
Applications of ethical practice in the clinical setting can extend
beyond the individual level, to the family and community, even broader
societal responsibilities on patient advocacy, ethical values, social
justice and renewal of this world. Though there are limits to what each
of us can control, all share a responsibility to choose appropriately and
make our unique contributions as trusted and respected professionals.
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Educational Objectives
1. To introduce factors influencing improved patient outcomes
and the specific role of the psychotherapist
2. To identify legal and ethical issues in the consultation room
3. To apply legal and ethical understanding to develop the
therapeutic alliance
4. To develop a list of effective therapist behaviors influencing
treatment outcomes
5. To develop understanding of what can and cannot, should and
should not be done in clinical interactions
6. To apply legal and ethical understanding to successful
resolution of clinical dilemmas
7. To apply new learning to clinical work with patients, families
and community.
Content Outline
Following introductions, review of the workshop outline, lecture
notes, a confidentiality agreement, and informed consent to proceed,
seven major topics are spread over six hours. Each clinical topic is
followed by a brief review of case law and lecture notes that may assist
continued learning.
1. Contemporary Clinical Issues
Who determines what, when, how and why?
Current malpractice, disciplinary and ethical actions
Medical/Client records and emerging issues with electronic records
Fragmented patient
Medication management
Supervision and Consultation
Guidelines for the practice of tele-psychology
Hotspots in Ethics
2. What Makes Psychotherapy Work?
Scope of practice
Scope of competencies
Professional responsibilities
Boundary violations
The working alliance
Criteria related to improved outcomes
3. What Is To Be Treated?
Purposes of comprehensive diagnostic evaluation
Comprehensive Diagnostic Evaluation:
Problems
Family history
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Psychodynamic
Diagnostic DSM V
Prognosis
Treatment recommendations
Anticipate interactional issues
Informed consent on therapeutic planning and procedures
Tasks, Techniques and Timelines
What has already been accomplished?
Autonomy
Shifting balances in advocacy, dependency and self-responsibility
Third party payors and creative aggression
Pre-treatment expectations
Confidentiality
Reporting
Mandated reporting when applicable
4. Beginning Treatment
Listening and interview structure
To be understood
Problem solving
Confrontation
Clarification
Hypothesizing
Working Through
Anticipatory Interventions
Treatment Review
Working alliance
5. Staying In Treatment
Therapeutic Focus
Tracking themes
Standardized techniques/ Common factors
Repetition
Transference
Resistance revisited
Countertransference
Perceived enactments
Impasse
Idiosyncratic cueing
Supervision
Consultation
Documentation
Measuring progress
Confronting obstacles/detours along pathway
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6. How Much Is Enough Treatment?
Termination Issues
Pragmatic criteria:
Symptoms
Goals
Developmental trauma
Natural endings
Self-analysis
Goodbye for now sometimes
7. Beyond The Individual: Societal Responsibilities
Social justice
Special vulnerable and at-risk populations
Women issues
Mental illness and the prisons
Aging of the population
Bridges into the community
8. In Closing: So What?
Renewing your standards and avoiding professional burnout
Defining and practicing your standardized techniques
Review of ten functions of the professional psychotherapist
Educational Methods
An interactive format begins with large group discussion designed
to involve participants, assess needs and define problems for
consideration in the seminar. Focused discussion related to content will
occur in response to brief lectures and case discussions. Lecture notes
and references are used. The approach is pragmatic, integrative and
clinically based with an attitude of inquiry about effective and
systematic professional practice.
Evaluation
Clear and direct interactive discussion provides informal and
immediate feedback. A questionnaire distributed at the end of the first
three hour session will assess the group experience, ask for more
specific questions and comments shaping the next session. At the
conclusion of the seminar the formal evaluation questionnaire will invite
comment on next steps the individual may pursue in being responsible
for their own professional development.
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