Legal and Ethical Decisions

imgresI passed my licensing exam a few weeks ago and am opening a private practice. I understand I now have to attend continuing education or training in law and ethics during every two-year renewal cycle. My practice will be pretty simple, and I don’t expect any legal issues to arise. I’ve always been an ethical person, so I also don’t foresee any problems there either. What is the reason for the requirement for all licensed practitioners?  

It is common for practitioners to think this requirement is unnecessary and burdensome and for newly licensed therapists to under-estimate the likelihood of a legal or ethical issue arising in their practices. I can’t explain the reasoning of the licensing boards, but I will give you my thinking on ways clinicians can maintain ongoing awareness of legal and ethical issues.

First, it is important to stay current on legal and ethical standards. You studied this extensively to pass your licensing exam, but you will need to keep up to date on new legislation that affects clinical practice as well as case law and changes in regulations. In addition to continuing education, you can make sure you are working with current information by joining your local, state, and national professional associations and following the updates they distribute to members. New laws and regulations are sometimes confusing, and it may be helpful to review a few different sources to make sure you are clear about your legal and ethical obligations.

Second, check your information when you need to make a decision. This is especially important when you are faced with a new or unfamiliar situation, but it is a good idea in general. Often the general guideline you hold in mind is one that represents a combination of interpreting an original source like your professional ethics code, remembering what your teachers and supervisors told you, and making your own internal judgment based on common sense. All of these sources contribute to ethical decision making, but over time your understanding may become more vague and shift in the direction of what you feel or assume rather than what is stated in the applicable law or ethical principle. Reviewing the primary source or at least a summary by an expert can correct for the changes that take place in memory and judgment over time.

Third, notice any discomfort you feel regarding issues like child abuse reporting, billing practices, dual relationships, and other common situations of legal and ethical importance. Just as your countertransference feelings can alert you to a clinical issue that needs attention, they can also alert you to an issue you are overlooking or stretching beyond the limits of ethical practice. If you find yourself justifying a decision, feeling defensive, or discounting a sense of unease, pause to examine the issue and your decision. Your discomfort may be a sign that you are making an unsound choice.

Last, seek consultation from peers or an expert consultant. It is helpful to have a regular schedule of consultation on a weekly or monthly basis, but if that isn’t possible, identify someone you can talk with as needed. If you are facing a decision or dilemma and are reluctant to share it in consultation, that is a red flag that your decision may not be in compliance with legal and ethical standards. It is better to recognize and correct an error than to continue on a path of poor decision making that may result in a larger problem in the future.

I hope you find this helpful in increasing your understanding of legal and ethical dilemmas and ways to insure that your practice remains fully compliant with regulations. Please email me with comments, questions, or suggestions for future blog topics.