In Washington state, all licensed mental health types must take an ethics class every two years. I try to take a different one each time. I often wonder how an issue that can be so alive in a consultation session can be deadly dull in a lecture hall. It can be. Any new perspective or glint of new information is helpful. Here’s what I learned from Judy Roberts in Cascadia Training’s Professional Ethics: Not for the Faint-of-Heart workshop:

In every file we need a sheet of paper called: Protected Client Information, Accounting of Disclosures on which you must put the client’s name and ID#. The columns must have the date of disclosure, the name and address of the recipient, a brief description of Protected Information, and a Brief Statement of Purpose of Disclosure.   Okay. I can do that. But I will never have to, or possibly never have to. Why? Because these are the disclosures that are NOT required to be included in this Accounting. (Pay Attention!)

  • Disclosures made for treatment, payment, and operations of your practice.
  • Disclosures and use of client information permitted or required by law.
  • Disclosures made to people involved in client’s care. This one is more germaine to medical care, than mental health care.
  • Disclosures made to correctional institutions or law enforcement officials.
  • Disclosures made to the client at client’s request.
  • Disclosures made in response to a release of information signed by the client.
  • Disclosures made for national security or intelligence purposes.
  • Disclosure made that do not include client identifiers (name, address, place of work–in consultation, for instance.)

So can you imagine any instance during which you would enter anything on this page? You need it in the file anyway.

I learned that in 1998 or so, the WA state legislature, by accident, gave all licensed mental health people (MFT’s, MSW’s, MHC’s with licenses) de facto client privilege. It seems that the statutes were passed late in the season and late at night, and they forgot to take away our clients’ right to privilege. Until there is a lawsuit about it, we have the same status, by default, as clinical psychologists and psychiatrists. As it stands, you would need a direct order from a judge, not just a supeona, to release information. Roberts said to talk to a lawyer before making any of these disclosures.

A lawyer told Roberts, "If you take something out of a client’s file, you need a legal paper (like a release of info or a court order) ot put into the file."

Her ethical decision-making model: I.D. the ethical problem; the stake-holders involved; and the relevant laws or principles. Generate courses of action. Consider consequences for each course of action. Pick the best one. And document, using the model: Describe in terms of opposing principles (tx vs law or this good vs. that good). Reference the relevant guidelines/laws. Note options. Note risks of each option. Document consultation: who, what, when, and recommendations. Describe the action taken and the client’s response.

She spent the afternoon talking about dual relationships and boundaries. (If only I hadn’t been a social worker since 1981. . . ) I liked the discussion of "boundary crossing: Functioning in relation to a client in a manner that is more typical of another type of role relationships." vs. "boundary violation: Breach of professional role boundaries that results in harm to the client or the therapeutic relationship." 

Roberts talked about "train wrecks" that occur when therapists try to make up for clients’ deficits, by, for instance, moving the clients into the therapists homes. I think that would be "violation". van der Hart (see below about 4 posts) says this happens when therapists see only the "Emotional Parts" and don’t get the "Normal", adult parts to take care of their own inner needy parts. He said very dissociative folks bring this "urge to take over and take care" out in many therapists. Watch out for it in you.