Welcome to Unit 6: Welcome to Unit 6: Record KeepingRecord Keeping

Erin Hunt-Carter, Ph.D.Erin Hunt-Carter, Ph.D.

Class BusinessClass Business GradingGrading

Readings: Readings: • Chapter 9 Chapter 9 • Chapter 13Chapter 13

• Any questions about the project? Any questions about the project?

Record KeepingRecord Keeping Why must we keep records?Why must we keep records?

Record KeepingRecord Keeping AssessmentAssessment TherapyTherapy ResearchResearch EducationEducation Forensic settingsForensic settings Industrial/Organizational ContextsIndustrial/Organizational Contexts

Is this ethical?Is this ethical? Dr. Shapiro has retired from her Dr. Shapiro has retired from her

psychotherapy practice. Two years after psychotherapy practice. Two years after retirement, she gets a diagnosis of terminal retirement, she gets a diagnosis of terminal cancer. She is not expected to live more than cancer. She is not expected to live more than six months. She carefully shreds all of her six months. She carefully shreds all of her therapy documents and has them burned in therapy documents and has them burned in order to protect the confidentiality of her order to protect the confidentiality of her clients after she is gone. clients after she is gone.

How long must we keep records?How long must we keep records? Seven years after the end of contact Seven years after the end of contact For children: Until they are 21 years old (3 For children: Until they are 21 years old (3

years past majority) or seven years, depending years past majority) or seven years, depending on which is later.on which is later.

Is this ethical?Is this ethical? Dr. Grant is a psychologist working as a Dr. Grant is a psychologist working as a

psychotherapist. She saw Mr. Saunders for 11 psychotherapist. She saw Mr. Saunders for 11 sessions in 2008. Mr. Saunders only paid for 4 sessions in 2008. Mr. Saunders only paid for 4 of those 11 sessions. This week, Mr. Saunders of those 11 sessions. This week, Mr. Saunders came to her office and requested that she send came to her office and requested that she send his complete psychotherapy notes to his family his complete psychotherapy notes to his family doctor. Dr. Grant stated that she would only doctor. Dr. Grant stated that she would only send the notes from the sessions for which she send the notes from the sessions for which she was paid. was paid.

What would you do?What would you do? Amy Hill is a psychotherapist. She saw Ms. Amy Hill is a psychotherapist. She saw Ms.

West for 9 sessions in 2011. Mr. Saunders West for 9 sessions in 2011. Mr. Saunders only paid for 3 of those sessions. Earlier only paid for 3 of those sessions. Earlier today, Ms. West attempted suicide. Amy today, Ms. West attempted suicide. Amy received a signed release of records form and received a signed release of records form and request for all of her psychotherapy notes from request for all of her psychotherapy notes from the emergency department. the emergency department.

6.03 Withholding Records for Nonpayment6.03 Withholding Records for Nonpayment

““Psychologists may not withhold records Psychologists may not withhold records under their control that are requested and under their control that are requested and needed for a client's/patient's emergency needed for a client's/patient's emergency treatment solely because payment has not been treatment solely because payment has not been received.”received.”

Who is right?Who is right? Dr. Hastings saw Ms. Brenner for 16 sessions about 10 Dr. Hastings saw Ms. Brenner for 16 sessions about 10

months ago. Ms. Brenner did not pay for the last five months ago. Ms. Brenner did not pay for the last five sessions. Dr. Hastings contacted Ms. Brenner by letter sessions. Dr. Hastings contacted Ms. Brenner by letter and informed her that if she did not pay her outstanding and informed her that if she did not pay her outstanding balance within 30 days that she would turn her over to a balance within 30 days that she would turn her over to a collection agency. Ms. Brenner was furious and accused collection agency. Ms. Brenner was furious and accused Dr. Hastings of threatening to violate her confidentiality. Dr. Hastings of threatening to violate her confidentiality. She insists that by sending her to collections she is She insists that by sending her to collections she is disclosing that she was in therapy. And is afraid the disclosing that she was in therapy. And is afraid the collections agency will tell her family about the therapy. collections agency will tell her family about the therapy.

6.04 Withholding Records for Nonpayment6.04 Withholding Records for Nonpayment

(e) If the recipient of services does not pay for (e) If the recipient of services does not pay for services as agreed, and if psychologists intend services as agreed, and if psychologists intend to use collection agencies or legal measures to to use collection agencies or legal measures to collect the fees, psychologists first inform the collect the fees, psychologists first inform the person that such measures will be taken and person that such measures will be taken and provide that person an opportunity to make provide that person an opportunity to make prompt payment.prompt payment.

Barter for Therapy or AssessmentBarter for Therapy or Assessment Is it ever acceptable? Is it ever acceptable?

6.05 Barter With Clients/Patients6.05 Barter With Clients/Patients ““Barter is the acceptance of goods, services, or Barter is the acceptance of goods, services, or

other nonmonetary remuneration from other nonmonetary remuneration from clients/patients in return for psychological clients/patients in return for psychological services. Psychologists may barter only if (1) it services. Psychologists may barter only if (1) it is not clinically contraindicated, and (2) the is not clinically contraindicated, and (2) the resulting arrangement is not exploitative.”resulting arrangement is not exploitative.”

Barter for Therapy or AssessmentBarter for Therapy or Assessment What are the special ethical considerations a What are the special ethical considerations a

psychologist must make?psychologist must make?

Barter for Therapy or AssessmentBarter for Therapy or Assessment What are the special ethical considerations a What are the special ethical considerations a

psychologist must make?psychologist must make? Client harm or exploitationClient harm or exploitation Power differentialPower differential Multiple relationshipsMultiple relationships How do you value a bartered good or service?How do you value a bartered good or service?

Is This Ethically Sound?Is This Ethically Sound? Dr. Kulhanek is a psychologist working in a rural Dr. Kulhanek is a psychologist working in a rural

Utah. She agrees to conduct psychotherapy with a Utah. She agrees to conduct psychotherapy with a client who recently fled a polygamist compound. client who recently fled a polygamist compound. The woman has very little money, but offers to go The woman has very little money, but offers to go to Dr. Kulhanek’s house five days per week and to Dr. Kulhanek’s house five days per week and walk her dog for 15 minutes per day in exchange walk her dog for 15 minutes per day in exchange for one hour of weekly therapy. Dr. Kulhanek will for one hour of weekly therapy. Dr. Kulhanek will not be at home when the dog walking occurs and not be at home when the dog walking occurs and they agree that it will end when therapy is they agree that it will end when therapy is terminated.terminated.

Ethical Issues Working With Ethical Issues Working With Couples and FamiliesCouples and Families

Why might working in couples or family Why might working in couples or family therapy be more complicated from an ethical therapy be more complicated from an ethical perspective than working with a single client?perspective than working with a single client?

What would you do?What would you do? ““A gay couple had been in counseling for several A gay couple had been in counseling for several

sessions. One member of the couple called the sessions. One member of the couple called the psychologist and revealed that, without the knowledge of psychologist and revealed that, without the knowledge of his significant other, he had begun seeing his former wife his significant other, he had begun seeing his former wife in what was progressing toward a renewal of their sexual in what was progressing toward a renewal of their sexual relationship. The client asked the psychologist to keep the relationship. The client asked the psychologist to keep the information secret. Although the psychologist had information secret. Although the psychologist had communicated a general confidentiality policy to the communicated a general confidentiality policy to the couple at the outset of therapy, she had not specifically couple at the outset of therapy, she had not specifically discussed with them her policy regarding secrets between discussed with them her policy regarding secrets between her and one member of the couple… (Fischer, 2009, pp. her and one member of the couple… (Fischer, 2009, pp. 297-298).”297-298).”

10.02 Therapy Involving Couples 10.02 Therapy Involving Couples or Familiesor Families

““(a) When psychologists agree to provide services (a) When psychologists agree to provide services to several persons who have a relationship (such as to several persons who have a relationship (such as spouses, significant others, or parents and children), spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset (1) they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) which of the individuals are clients/patients and (2) the relationship the psychologist will have with the relationship the psychologist will have with each person. This clarification includes the each person. This clarification includes the psychologist's role and the probable uses of the psychologist's role and the probable uses of the services provided or the information obtained.”services provided or the information obtained.”

What would you do?What would you do? You have a first session with a new client. You have a first session with a new client.

Throughout the first session, you keep thinking that Throughout the first session, you keep thinking that she seems very familiar. Halfway through the she seems very familiar. Halfway through the session you realize that you dated her briefly in session you realize that you dated her briefly in high school. You never had intercourse with her, high school. You never had intercourse with her, but you did pretty much everything else. It’s but you did pretty much everything else. It’s twenty years later now, and you don’t know anyone twenty years later now, and you don’t know anyone in common, so you figure that there is little harm in in common, so you figure that there is little harm in seeing her as a client. After all, you were just seeing her as a client. After all, you were just teenagers when you dated!teenagers when you dated!

10.07 Therapy with Former Sexual Partners10.07 Therapy with Former Sexual Partners

Psychologists do not accept as therapy Psychologists do not accept as therapy clients/patients persons with whom they have clients/patients persons with whom they have engaged in sexual intimacies.engaged in sexual intimacies.

What would you do? What would you do? You are starting to get serious with your You are starting to get serious with your

boyfriend, and he takes you to meet his boyfriend, and he takes you to meet his parents. You walk in the door and are parents. You walk in the door and are mortified to realize that his mother is your mortified to realize that his mother is your client. She used her maiden name in therapy, client. She used her maiden name in therapy, and you never made the connection. Now you and you never made the connection. Now you realize she has spent much time in therapy realize she has spent much time in therapy talking about your boyfriend, and even about talking about your boyfriend, and even about his relationship with you. What do you do? his relationship with you. What do you do?

10.06 Sexual Intimacies with Relatives or Significant 10.06 Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/PatientsOthers of Current Therapy Clients/Patients

Psychologists do not engage in sexual Psychologists do not engage in sexual intimacies with individuals they know to be intimacies with individuals they know to be close relatives, guardians, or significant others close relatives, guardians, or significant others of current clients/patients. Psychologists do of current clients/patients. Psychologists do not terminate therapy to circumvent this not terminate therapy to circumvent this standard.standard.

Questions or comments?Questions or comments?