Leonard —a Ruder awakening

 

 

This is my experience, opinion and part of a complaint I filed with the Ct. Department of Public Health regarding my experience with a therapist in CT.. The case is closed, and it is now public information. The Ct. DPH’s consultant LCSW somehow found that no violation of State Statutes occured. However there was a small success in that the therapist was asked to complete CEU’s in “office and biiling practices” and “client/therapist boundaries”. He was also forced to pay back the money he “overbilled” the insurance company for and to drop himself as a provider. I’ve been told that these are “relative victories” in dealing with a licensing agencies, as they normally dismiss 80% of all complaints up front, and only actually discipline 2% of all therapists that are complained about.

Leonards(timeline) Billing History and “insurance fraud” and “post therapeutic relationship”
2004: Leonard Billed appropriately for 5 sessions that took place in 2004.

2005: Leonard billed appropriately from January of 2005 until September 3, 2005. After this time there are no claims filed through the December 30, 2005. There is no paperwork within the petition file to show claims made, denied or paid for this time period.

However:
In March 2006 Leonard told me that I owe him money from 12 sessions in the fall of 2005 he did not get paid for by A****Insurance. He said, “you owe me some money, your insurance company did not pay me for sessions during that time period. At the time I believed him, and made a payment schedule and paid it off by July 15th of 2006.I asked for but never received an actual bill, nor did I receive receipts In October of 2006 while on the phone with A**** Insurance, regarding separate matter unrelated to this case, I asked the representative why I owed Leonard this money and if and why they denied the claims. I was told by the representative that Leonard did not file paperwork at all for that time period and that by contract I was held harmless and owed him nothing. It was too late and I had already paid Leonard the money he claimed I owed him. I did confront him at our next session but he claimed at the time that he had filed paperwork and that he would check into it. Time went by and I neglected to ask him about it. It was only a few months later that he triple billed for various dates in January 2007 and February 3rd, 2007.

2006: Leonard billed weekly and appropriately from January 7, 2006 to June 3, 2006. Then in “similar fashion” to 2005, he did not submit claims from after June 3, 2006 through December 29, 2006 ….until December 30, 2006.

On December 30, 2006Leonard submitted claims for sessions dating back until June 17, 2006 to December 30, 2006…a total of 23 sessions. Looking at the payments made in the petition file it appears that some of Leonard’s claims were rejected at this time. I do not know exactly why, but I believe it would be either because of A***Insurance “timely filing” requirements, or Leonard may have needed to obtain authorization for “additional sessions” (beyond an automatic 20 per year) and did not attempt to do so.
A client is “held harmless” in both of these situations.

2007: In January 2007 Leonard billed for sessions twice weekly,Tuesdays and Saturdays, for the entire month of January and February 3, 2007, on February 3, 2007.

I saw him 3 times in January of 2007 and ( 1/7, 1/21, 1/28) and on 2/4 as shown on my calendar (I did not see him on February 3, 2007)

I discovered this on 3/3/07 by checking my billing on line on A****Insurance website.

I confronted Leonard regarding this “insurance fraud” and made a deal with him that he was not to bill A***Insurance for my next 7 sessions in order to make up for those he already “got paid for” I was willing to let it go with this arrangement. On May 8, 2007 I received a letter from A***Insurance authorizing an additional 6 sessions. I immediately realized this meant he violated our verbal agreement and billed anyway. I again checked my claims on A**** Insurance website and saw that Leonard had billed once weekly (if we had a session) from 2/4/07 until 4/29/07.

I immediately confronted him in an email. This was then followed by a phone call from him at 1120 pm. Leonard took an aggressive stance, yelling at me over the phone that my “ expectations were too high” and that I had a “holier than thou attitude”. He also said in a very nasty tone “what would you like me to do about it?!” He also claimed during this phone call that he “was just trying to see how fast A*** Insurance would “turn over benefits” which made absolutely no sense to me. I felt sick after this phone call and my “BS meter was spinning” I followed up with another email the next day.
After a couple emails and a couple phone calls Leonard agreed to meet me at my house to fully discuss the issue on 5/12/07. While here he cried his “crocodile tears” trying to gain my sympathy. He claimed his “son was suicidal” and that he and his wife had made some “poor investment choices”, that they were close to bankruptcy, and might have to sell their house. He managed to gain my empathy, but certainly not my trust. Leonard wanted the opportunity to earn my trust again so I agreed to meet with him on a weekly basis, not as a therapist, but only as a human being who wanted to prove he was trustworthy. I was feeling extremely conflicting emotions, and it is then I said to him “you can no longer be my therapist, but you’re not my friend either, I do not know what to call it”. This was a phrase I said to him at least 3 times in separate discussions in the next few months.

Please see the attached schedule for info regarding the times we met, as well as my calendar included in this letter. (There are major inconsistencies with his scheduling of clients in his “billing grid” at times when I saw him other clients are listed)
I also made it very clear to Leonard that I wanted him to pay back A*** Insurance for the sessions he “stole”, and did not particularly care how he did this.

I also asked for the money he had taken from me back in 2006. He said he would write a check to a charity in my name, but did not offer to write a check directly to me.

I continued to meet with Leonard for several months in a relationship I still do not have a name for other than “former therapist and former client”. These meetings were highly unproductive, we would take a walk, and talk, it was mostly what Leonard calls in his notes, “chit-chat”, although Leonard still tried at times to play the “therapist role”.

The trust was never rebuilt. I would ask him at times if he thought of how to pay back the insurance company and he either would not respond, change the subject or say that he couldn’t do that as it would “open up a whole can of worms” and he would not do that.

Over time, these sessions became further between and nothing was being accomplished. I strongly believe that Leonard had no intent to pay the insurance company back and that the only reason he was meeting with me was to ensure that I was not going to turn him in.

Obviously “this game” could not go on forever.

The New Year was coming around and I was quite tired of carrying this “burden”. On December 31,2007 I anonymously reported an “insurance fraud” claim to A*** Insurance’s SIU unit.

Leonard was contacted by A**** Insurance and by early February.

At the end of my morning session on 2/2/08 Leonard told me he was being audited by A**** Insurance. (but he did not know I was the one who turned him in as the complaint I made was originally anonymous.). He said this was his “worst nightmare”, and asked me to consider changing the dates that I saw him. I emailed Leonard later in the week and said “no” and that I would not lie for him.

On 2/9/08, at the end of my session Leonardtold me he had spoken to an attorney regarding the audit and that the attorney told him “someone probably turned him in” and asked me if I was the one who did. Feeling absolutely terrified I said “yes”. I do not recall the conversation immediately following. I could not stay at his office to further discuss it as I had an event to attend that I needed to arrive at by at 1130 am in town. I do not recall how we got in contact later in the day, email or phone, but Leonard wanted to further discuss the situation.

In retrospect, I never would do this again! I went back to his home office for 430 pm and we talked until 930 pm. I was fearful enough going there that I asked a couple of friends to call and check to make sure I was ok.
Leonard asked me to bring along my calendars for the previous two years so that I could give him the dates I actually saw him. This is the very first thing that occurred after I arrived at 430 pm.
During the course of this meeting Leonard said the following:
Leonard said “I could go to jail for this” (speaking about himself)
Leonard made a big deal and said “I forgive you for what you’ve done”
Leonard said to me “you went outside the relationship”
Leonard said “My son was suicidal before this might put him over the edge”
Leonard said “I will never be with a man as long as I deal with issues this way.”
Leonard said “He will feel very sorry for me when I realize what I’ve done”. (by turning him in)
Leonard called me self righteous and said I had a” holier than thou” attitude.
As I was leaving his office Leonard last words he said astonishingly were “too bad I can’t get paid for this”
It was an extremely emotionally draining experience to say the least. I felt “beat up” and had a bad headache afterward.

I only saw Leonard one time after that and that was so I could put closure on the relationship. On or about August 14, 2008 I met with Leonard and (finally) officially “fired” him as my therapist. Through his self disclosure and my experience with Leonard, he does not appear to like to put closure on relationships and likes to leave things “open ended”. While this is good in theory, I find a final closing (at least of “a phase” of any relationship) necessary to move forward.

To Summarize:

During the investigation of my original petition it was found that there was “no pattern indicating Leoanrd intentionally committed fraud” and that fraud could not be proven. While it could not be proven that Leonard “wrongfully billed” more than myself and my ex husband…there was a pattern in his billing on my account as can be seen from the previous writing here.

It appears to me that in January 2007, upon rejection of his claims from 2006 for timely filing ( for my sessions) or other reasons, perhaps Leonard sat down and “intentionally” tried to recover monies he essentially ( for lack of better terms)“screwed himself out of”, through his “lack of billing”…. I would call this Insurance Fraud”.

This is not “sloppy record keeping or sloppy billing” it is just not billing, then willingly and intentionally filling out paperwork for the sessions in January 2007 that did not occur “to recover the funds”. “Being Busy” and not having time does not seem to be an issue to me either as in reviewing Leonard’s (highly inaccurate) “psychotherapy notes” of me in the petition file, he apparently had time to write 6 to 12 page “rants” allegedly about me (these notes showed clearly the counter-transferrence he was experiencing)….and the content of the notes is certainly questionable as to it’s factual nature. ( really many enteries are falsified) I do not believe these notes were all written right after sessions, but no matter when they were written, I think Leonard’s time would have been better spent working on his billing.

There was an apparent pattern here as Leonard had a pattern of “not billing” and then later trying to recover money from me.Then, when he knew that wouldn’t work again, he tried to recover the money from A**** Insurance, but I discovered that as well. While he did not steal money from me in 2007 as he did in 2006, he stole sessions, which have a monetary value for me. These can be limited in number by A*** insurance as they have to approve sessions beyond an automatic 20 per year. For additional sessions it is my understanding that proper documentation must be provided and/or authorization given. Perhaps Leonard did not want to do the work to file this information. From what I see paperwork does not exist in the petition file to show that he at least attempted to get additional coverage.

In conclusion, Leonard lied to me in 2006 regarding not getting paid by A****Insurance for sessions in the Fall of 2005, and lied to A**** Insurance in January of 2007 by triple billing for sessions that month. Did he do this to recover the money from claims “rejected” in 2006? It would appear so to me. Had he not lied to me previously in 2006, I would not have had reason to track his billing to A**** for my sessions, but I had reason to believe that Leonard might “do it again”.

To Reap Psychotherapy’s Benefits, Get a Good Fit

http://www.nytimes.com/2007/08/21/health/21beha.html?_r=1

A slightly dated, but informative article on the therapeutic relationship from the new York Times (2007)

Americans seem to like psychotherapy. Whether it’s for the mundane conflicts of everyday life or life-threatening illnesses like major depression, psychotherapy is widely viewed as a healthy, if not harmless, pursuit.

Yet unlike most other medical treatments, psychotherapy can take considerable time. An infection can be cured in days, but remission of severe depression or anxiety disorder usually takes weeks or months, and a personality disorder typically requires years of intensive psychotherapy.

So if the outcome may be months or years away, how can a person tell whether his psychotherapy is any good?

It’s harder than you’d think. For one thing, people… (to read more click the above link)

“License to harm” Mental health Standards from Seattle

 

….and I thought Mental Health Care standards were low in Connecticut! These from Washington are staggering!

http://seattletimes.nwsource.com/html/licensetoharm/2002949517_sexmed24.html

What to look for in a Therapist from Ofer Zur Ph.D

This is a pretty good checklist…I agree with all but the “expert” in #15…knowledable and professional yes, expert not necessary… and an ego trip label for the therapist
http://www.zurinstitute.com/choosing.html
How To Choose A Therapist

By Ofer Zur, Ph.D.
Director, Zur Institute, http://www.ZurInstitute.com

What To Look For
If you or a loved one is looking for a therapist, look carefully over the checklist below. If you are already in therapy, consider going over the list with your therapist as a way to evaluate your progress. Remember, there is a dangerously wide range of psychotherapists in practice. While many are competent and ethical, many more are injured people who enter the profession for the wrong reasons.

Be sure that 21 of the 22 items are checked.

If not, engaging this particular therapist may be costly to your pocketbook and hazardous to your mental health.

Checklist for Choosing a Therapist
Seems warm and accepting. Has a sense of humor, however willing to challenge you when necessary.

Is emotionally healthy. Seems to feel at ease with himself/herself. Does not seem anxious, arrogant or depressed.

Does not suffer from a God complex. Decent, respectful, not condescending. Neither shows off, belittles nor demeans. Check walls for over-abundance or certificates, awards or prizes. Check for excess of jewelry, silver, or gold.

Is trained in talk therapy, not just in “pill therapy. ” Watch out for someone who offers medication (e.g., Prozac) as the solution to your problems.

Accepts and encourages the idea that clients are entitled to shop around for a therapist before they commit. Is willing to talk to you on the phone for at least 10 minutes so you can interview him/her thoroughly.

Accepts the idea that consultation or second opinions may be helpful in the course of therapy.

Lets you explain your problems, doesn’t tell you what they are prematurely or try to fit you into a standardized box (e.g., co-dependent, you have been molested, etc).

Is active and engaged. Quit right away if the therapist avoids discussions, does not answer most questions, or pretends to be a “blank wall. ” Successful therapy needs ongoing dialogue and authentic relationships.

Has more than one clinical orientation and promises to fit his/her approach to your specific problems and not impose his/her pet approach on all patients.

Is flexible in terms of what is appropriate and helpful. Contrary to common practice, some clients can benefit from a walk in the park or a home visit; and a touch still has more healing power than volumes of words.

Is not rigid or paranoid about seeing you or engaging with you in the community. Accepts that you may bump into each other during religious services, your children’s school or on the basketball court. Does not hide behind the professional persona.

Presents you with clear office policies, including limits of confidentiality, clients’ rights, etc. Read the contract carefully before you sign.

Talks to you on the phone in between sessions if necessary.

While flexible in many ways, still maintains clear and healthy boundaries. No hugging unless you initiate it, no sexual innuendo, no business offers.

Seems professional, knowledgeable, and an expert (writer, teacher, supervisor) and above all competent, human and experienced.

Communicates well with parents when treating children and adolescents. A delicate balance must be reached between respecting adolescents’ privacy and not keeping parents in the dark.

Does not focus exclusively on your childhood or inner life. Make sure that the effects of real-life pressures, such as long commute, children or harassing boss, are dealt with.

Shares your basic moral and political values but does not work hard to prove to you how much they are like you (e.g., “I was molested too “). It’s okay to ask about the therapist’s values.

Is flexible about who can be part of therapy. At times, it is helpful to bring your friend/lover, child, or parent with you to therapy.

Conducts regular evaluations of progress in therapy, including discussion of treatment plans. Listens to your assessment of what is helpful and what is not during the course of therapy.

Takes responsibility for not being effective when therapy does not progress over time. When therapy has not yielded any significant results for a long time, neither blames you nor continues to take your money.

Is willing to go over this list with you without being offended or defensive

NASW Ethics Code “wishy-washy”

How strong can the NASW ethics code be when the words “should”/”should not” appear 70+ times in just section 1!

you can count for yourself here or below…

http://www.naswdc.org/pubs/code/code.asp …or below….

The only act expressly prohibited by the code is having sexual relations with a client.(Sec1.09)

Even section 1.11 on Sexual Harassment only states that “Social workers should not sexually harass clients. Sexual harassment includes sexual advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature.”

So what gives folks! You have an ethics code that a LCSW can run circles around and violate all but one aspect of that code without recourse or being concerned as to the outcome of unethical actions. “Should’s” and “should nots” are wide open to interpretation and do not serve to enhance the professions credibility or protect the interests of a client.

Sure, living life is hazardous in itself… and there is no guaranteed “safety” contract anywhere, but an ethics code of a professional organization must support the ideals of the organization in order to maintain it’s integrity…”should’s and should nots” are weak, unstable and to say it simply….”wishy-washy”

Section one of the NASE Code of Ethics
1. SOCIAL WORKERS’ ETHICAL RESPONSIBILITIES TO CLIENTS
1.01 Commitment to Clients
Social workers’ primary responsibility is to promote the well­being of clients. In general, clients’ interests are primary. However, social workers’ responsibility to the larger society or specific legal obligations may on limited occasions supersede the loyalty owed clients, and clients should be so advised. (Examples include when a social worker is required by law to report that a client has abused a child or has threatened to harm self or others.)

1.02 Self­Determination
Social workers respect and promote the right of clients to self­determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients’ right to self­determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.

1.03 Informed Consent
(a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third­party payer, relevant costs, reasonable alternatives, clients’ right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions.

(b) In instances when clients are not literate or have difficulty understanding the primary language used in the practice setting, social workers should take steps to ensure clients’ comprehension. This may include providing clients with a detailed verbal explanation or arranging for a qualified interpreter or translator whenever possible.

(c) In instances when clients lack the capacity to provide informed consent, social workers should protect clients’ interests by seeking permission from an appropriate third party, informing clients consistent with the clients’ level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients’ wishes and interests. Social workers should take reasonable steps to enhance such clients’ ability to give informed consent.

(d) In instances when clients are receiving services involuntarily, social workers should provide information about the nature and extent of services and about the extent of clients’ right to refuse service.

(e) Social workers who provide services via electronic media (such as computer, telephone, radio, and television) should inform recipients of the limitations and risks associated with such services.

(f) Social workers should obtain clients’ informed consent before audiotaping or videotaping clients or permitting observation of services to clients by a third party.

1.04 Competence
(a) Social workers should provide services and represent themselves as competent only within the boundaries of their education, training, license, certification, consultation received, supervised experience, or other relevant professional experience.

(b) Social workers should provide services in substantive areas or use intervention techniques or approaches that are new to them only after engaging in appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques.

(c) When generally recognized standards do not exist with respect to an emerging area of practice, social workers should exercise careful judgment and take responsible steps (including appropriate education, research, training, consultation, and supervision) to ensure the competence of their work and to protect clients from harm.

1.05 Cultural Competence and Social Diversity
(a) Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures.

(b) Social workers should have a knowledge base of their clients’ cultures and be able to demonstrate competence in the provision of services that are sensitive to clients’ cultures and to differences among people and cultural groups.

(c) Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability.

1.06 Conflicts of Interest
(a) Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients’ interests primary and protects clients’ interests to the greatest extent possible. In some cases, protecting clients’ interests may require termination of the professional relationship with proper referral of the client.

(b) Social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests.

(c) Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.)

(d) When social workers provide services to two or more people who have a relationship with each other (for example, couples, family members), social workers should clarify with all parties which individuals will be considered clients and the nature of social workers’ professional obligations to the various individuals who are receiving services. Social workers who anticipate a conflict of interest among the individuals receiving services or who anticipate having to perform in potentially conflicting roles (for example, when a social worker is asked to testify in a child custody dispute or divorce proceedings involving clients) should clarify their role with the parties involved and take appropriate action to minimize any conflict of interest.

1.07 Privacy and Confidentiality
(a) Social workers should respect clients’ right to privacy. Social workers should not solicit private information from clients unless it is essential to providing services or conducting social work evaluation or research. Once private information is shared, standards of confidentiality apply.

(b) Social workers may disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client.

(c) Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed.

(d) Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible before the disclosure is made. This applies whether social workers disclose confidential information on the basis of a legal requirement or client consent.

(e) Social workers should discuss with clients and other interested parties the nature of confidentiality and limitations of clients’ right to confidentiality. Social workers should review with clients circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. This discussion should occur as soon as possible in the social worker­client relationship and as needed throughout the course of the relationship.

(f) When social workers provide counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual’s right to confidentiality and obligation to preserve the confidentiality of information shared by others. Social workers should inform participants in family, couples, or group counseling that social workers cannot guarantee that all participants will honor such agreements.

(g) Social workers should inform clients involved in family, couples, marital, or group counseling of the social worker’s, employer’s, and agency’s policy concerning the social worker’s disclosure of confidential information among the parties involved in the counseling.

(h) Social workers should not disclose confidential information to third­party payers unless clients have authorized such disclosure.

(i) Social workers should not discuss confidential information in any setting unless privacy can be ensured. Social workers should not discuss confidential information in public or semipublic areas such as hallways, waiting rooms, elevators, and restaurants.

(j) Social workers should protect the confidentiality of clients during legal proceedings to the extent permitted by law. When a court of law or other legally authorized body orders social workers to disclose confidential or privileged information without a client’s consent and such disclosure could cause harm to the client, social workers should request that the court withdraw the order or limit the order as narrowly as possible or maintain the records under seal, unavailable for public inspection.

(k) Social workers should protect the confidentiality of clients when responding to requests from members of the media.

(l) Social workers should protect the confidentiality of clients’ written and electronic records and other sensitive information. Social workers should take reasonable steps to ensure that clients’ records are stored in a secure location and that clients’ records are not available to others who are not authorized to have access.

(m) Social workers should take precautions to ensure and maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology. Disclosure of identifying information should be avoided whenever possible.

(n) Social workers should transfer or dispose of clients’ records in a manner that protects clients’ confidentiality and is consistent with state statutes governing records and social work licensure.

(o) Social workers should take reasonable precautions to protect client confidentiality in the event of the social worker’s termination of practice, incapacitation, or death.

(p) Social workers should not disclose identifying information when discussing clients for teaching or training purposes unless the client has consented to disclosure of confidential information.

(q) Social workers should not disclose identifying information when discussing clients with consultants unless the client has consented to disclosure of confidential information or there is a compelling need for such disclosure.

(r) Social workers should protect the confidentiality of deceased clients consistent with the preceding standards.

1.08 Access to Records
(a) Social workers should provide clients with reasonable access to records concerning the clients. Social workers who are concerned that clients’ access to their records could cause serious misunderstanding or harm to the client should provide assistance in interpreting the records and consultation with the client regarding the records. Social workers should limit clients’ access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that such access would cause serious harm to the client. Both clients’ requests and the rationale for withholding some or all of the record should be documented in clients’ files.

(b) When providing clients with access to their records, social workers should take steps to protect the confidentiality of other individuals identified or discussed in such records.

1.09 Sexual Relationships
(a) Social workers should under no circumstances engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced.

(b) Social workers should not engage in sexual activities or sexual contact with clients’ relatives or other individuals with whom clients maintain a close personal relationship when there is a risk of exploitation or potential harm to the client. Sexual activity or sexual contact with clients’ relatives or other individuals with whom clients maintain a personal relationship has the potential to be harmful to the client and may make it difficult for the social worker and client to maintain appropriate professional boundaries. Social workers—not their clients, their clients’ relatives, or other individuals with whom the client maintains a personal relationship—assume the full burden for setting clear, appropriate, and culturally sensitive boundaries.

(c) Social workers should not engage in sexual activities or sexual contact with former clients because of the potential for harm to the client. If social workers engage in conduct contrary to this prohibition or claim that an exception to this prohibition is warranted because of extraordinary circumstances, it is social workers—not their clients—who assume the full burden of demonstrating that the former client has not been exploited, coerced, or manipulated, intentionally or unintentionally.

(d) Social workers should not provide clinical services to individuals with whom they have had a prior sexual relationship. Providing clinical services to a former sexual partner has the potential to be harmful to the individual and is likely to make it difficult for the social worker and individual to maintain appropriate professional boundaries.

1.10 Physical Contact
Social workers should not engage in physical contact with clients when there is a possibility of psychological harm to the client as a result of the contact (such as cradling or caressing clients). Social workers who engage in appropriate physical contact with clients are responsible for setting clear, appropriate, and culturally sensitive boundaries that govern such physical contact.

1.11 Sexual Harassment
Social workers should not sexually harass clients. Sexual harassment includes sexual advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature.

1.12 Derogatory Language
Social workers should not use derogatory language in their written or verbal communications to or about clients. Social workers should use accurate and respectful language in all communications to and about clients.

1.13 Payment for Services
(a) When setting fees, social workers should ensure that the fees are fair, reasonable, and commensurate with the services performed. Consideration should be given to clients’ ability to pay.

(b) Social workers should avoid accepting goods or services from clients as payment for professional services. Bartering arrangements, particularly involving services, create the potential for conflicts of interest, exploitation, and inappropriate boundaries in social workers’ relationships with clients. Social workers should explore and may participate in bartering only in very limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community, considered to be essential for the provision of services, negotiated without coercion, and entered into at the client’s initiative and with the client’s informed consent. Social workers who accept goods or services from clients as payment for professional services assume the full burden of demonstrating that this arrangement will not be detrimental to the client or the professional relationship.

(c) Social workers should not solicit a private fee or other remuneration for providing services to clients who are entitled to such available services through the social workers’ employer or agency.

1.14 Clients Who Lack Decision­Making Capacity
When social workers act on behalf of clients who lack the capacity to make informed decisions, social workers should take reasonable steps to safeguard the interests and rights of those clients.

1.15 Interruption of Services
Social workers should make reasonable efforts to ensure continuity of services in the event that services are interrupted by factors such as unavailability, relocation, illness, disability, or death.

1.16 Termination of Services
(a) Social workers should terminate services to clients and professional relationships with them when such services and
relationships are no longer required or no longer serve the clients’ needs or interests.

(b) Social workers should take reasonable steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services precipitously only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects. Social workers should assist in making appropriate arrangements for continuation of services when necessary.

(c) Social workers in fee­for­service settings may terminate services to clients who are not paying an overdue balance if the financial contractual arrangements have been made clear to the client, if the client does not pose an imminent danger to self or others, and if the clinical and other consequences of the current nonpayment have been addressed and discussed with the client.

(d) Social workers should not terminate services to pursue a social, financial, or sexual relationship with a client.

(e) Social workers who anticipate the termination or interruption of services to clients should notify clients promptly and seek the transfer, referral, or continuation of services in relation to the clients’ needs and preferences.

(f) Social workers who are leaving an employment setting should inform clients of appropriate options for the continuation of services and of the benefits and risks of the options.

Should a client record therapy sessions?

Some therapists record their sessions with their clients for their own benefit and legal protection…my question is…should a client in order to protect themself legally from possible unethical acts and incompetance of a Mental Health Practitioner. also record the sessions with the therapist?
How many therpists are willing to allow or do allow a client to record their sessions?

Bad Therapy Red Flag #10 (Therapist sales pitches you to join an MLM)

Bad therapy Red Flag #10 Therapist “Sales Pitches” you to get involved in a MLM (Multi Level Marketing) Group he and his wife just “bought into”

Not much explanation needed here. My former therapist, L.Ruder, did attempt this not only with me but also with my ex-husband during his weekly session.

Fresh back from a trip to Canada and Niagara Falls, the therapist and his wife had attended a “seminar” that he “had” to tell me about. The seminar was a MLM seminar to sell cell phone EMF (electromagnetic frequency) protective devices….they came in the form of pendants, etc. I shut Mr Ruder immediately down in the middle of his sales “pitch”and told him I had no interest in MLM organizations regardless of what they were selling…to which I immediately got accused of being “closed minded”!. I had to reaffirm that this was not something I had any interest in….period… and was rather “put off” that he would start my session with this BS!

My “reaction” to being sales pitched by a therapist should not have become “grist for the mill” for the #therapy session and I was quite perturbed!
He did however “promise” to never bring up the subject again, but if I was to change my mind about this “awesome” opportunity I could contact his wife.

…and btw…when this was reviwed as part of the Licensing Complaint I filed with the Ct DPH…the Consultant didn’t see anything unethical about it…yeesh!

Red flag of bad therapy #9 : Insurance Fraud

Just a guess that many Mental Health Professionals out there who accept insurance have on occasion innocently billed incorrectly for sessions they’ve had with a client. As clients, and human beings, we understand “mistakes”, and providing you correct your error, it is only that …”an error” …and “no big deal” unless it continues to occur.

Here is Red Flag #9 : When a Therapist Commits insurance fraud!

Unfortunately you will rarely have this happen  until you’re well into your course of therapy! There is little you can do to prevent a therapist from double or triple billing you for sessions….but you can REPORT IT after it happens and then run from the alleged care of that therapist!

Do not try to work it out with the therapist!

The therapist was dishonest enough to commit fraud….it is very unlikely he/she is going to be honest with you and negotiate  “in good faith” to restore your sessions or return the money to the insurance company. Please…. believe me…I have been there! I made a deal to restore my sessions and the therapist “blew it off” and billed anyway.

You can read about that under my blog post “A Rude Awakening”https://wisdomovertime.wordpress.com/2010/10/11/imho/
Here are a few common ways for a therapist (and other providers) to commit insurance fraud from the National Health Care Anti Fraud association website :http://www.nhcaa.org/eweb/DynamicPage.aspx?webcode=anti_fraud_resource_centr&wpscode=TheProblemOfHCFraud

#’s 1,2,7,8,9 are more related to therapy than the others…

1.Billing for services that were never rendered—either by using genuine patient information, sometimes obtained through identity theft, to fabricate entire claims or by padding claims with charges for procedures or services that did not take place.

2.Billing for more expensive services or procedures than were actually provided or performed, commonly known as “upcoding”—i.e., falsely billing for a higher-priced treatment than was actually provided (which often requires the accompanying “inflation” of the patient’s diagnosis code to a more serious condition consistent with the false procedure code).

3.Performing medically unnecessary services solely for the purpose of generating insurance payments—seen very often in nerve-conduction and other diagnostic-testing schemes.

4.Misrepresenting non-covered treatments as medically necessary covered treatments for purposes of obtaining insurance payments—widely seen in cosmetic-surgery schemes, in which non-covered cosmetic procedures such as “nose jobs” are billed to patients’ insurers as deviated-septum repairs.

5.Falsifying a patient’s diagnosis to justify tests, surgeries or other procedures that aren’t medically necessary.

6.Unbundling – billing each step of a procedure as if it were a separate procedure.

7.Billing a patient more than the co-pay amount for services that were prepaid or paid in full by the benefit plan under the terms of a managed care contract.

8.Accepting kickbacks for patient referrals.

9.Waiving patient co-pays or deductibles and over-billing the insurance carrier or benefit plan.

The main weapon to fight insurance fraud for an individual is awareness, and that includes:
1. knowing your insurance plans coverage..
2. checking your billing on line with the insurance company!…often therapy clients are not sent any sort of hard copy to check the billing
3. know what diagnosis your therapist is billing under
4. Confronting a therapist with any discrepancies!

5. REPORTING FRAUD if it does occur!

The most important thing you can do is leave the therapist’s so called treatment and then REPORT  the insurance fraud to the insurance company and your State Department of Insurance. If Medicare is involved, REPORT IT! to them! Also File a complaint with the Licening Board in your State against the therapist.

Excessive self disclosure: bad therapy red flag #8

Your therapy is supposed to be about you! I know relatively little about my current therapist personally. Enough to know that the therapist is sane and enough to know that there have been times the therapist has had stuff to work through…but I have never been burdened with whatever issues they are. I know the therapist graduated from Columbia University. I know the therapist is divorced and has an adult child who is now married. I know this therapist attends a monthly peer group consultation, and in the past has attended individual therapy. Quite refreshing really! Outside of that there are a few details that I know….but again those details keep the therapist a authentic human being, not an icy, self proclaimed “expert” that places themself upon a pedestal, and then claims the client is idealizing them. I feel safe in sessions. Sessions are about me. The boundaries are crystal clear, yet not obtrusive!

My former therapist however flooded our sessions with information about his life that I really did not need to know.I didn’t need to know the following that appeared throughout multiple therapy sessions with him for 2+ years
…that he didn’t have the money to fix his pool
… that his mother underwent ECT when he was 6
… that his brother allegedly abused him
… that he was considered a good tennis player, but also was considered “uncoachable”
… that he was “thrown out” of a internship with a therapist he wanted to work with
… that his son had back pain, was very depressed, and suicidal
….and that he himself experienced suicidal thoughts and severe depression throughout his life
…that he used LSD to experience altered states of consciousness

Perhaps the one thing I didn’t need to know about that took up way too much space was the therapists new career pursuit in becoming a “public speaker”. This subject appeared in just about every session I had with him. This subject sometimes took up half of the session and other times continued beyond the “therapeutic hour” and included monologues about who he hired as a mentor, and how much money (he claimed $12000) he spent on this mentor, training’s he went to and the speeches he gave while there, subjects he wanted to talk about, and often enough, the therapist presenting his “talks” and written speeches to me in session. He’d spend time explaining how this was a “dream” of his and that he was “destined to fulfill it”. Not only did this subject infiltrate my sessions, it ended up invading my life.

Being an adult that was raised in a in a narcissistic family structure I developed tendencies to be a “caretaker and people pleaser” I felt like I had to help him… I did what people pleasers and caretakers do! I experienced him as someone who was “trying so hard and getting nowhere.” As a client I felt that maybe I was standing in his way, that sessions were taking up time that he could be working on “his dream”. I wanted him to be happy. My “people pleasing and caretaker tendencies” took over and I assisted him by finding him a few places to give public talks, he even came to our house (mine and my ex’s when we were married) to get help with a talk he was going to present at a high school. ( not just infiltrating my life, but my then husbands as well, he was also his client) He was very willing to accept the assistance, in fact, he seemed to think he was entitled to it. He had offered to buy my ex and I dinner in exchange for our help with his speech and then totally blew that off. There was no reciprocity.
This therapist also let me know that he had “fired 5 or 6 other clients” so he could have more time to work on his public speaking career. This essentially backfired on him when
( no suprise to me) he wasn’t just accepted as a wonderful and dynamic speaker. Apparently others didn’t think public speaking was his natural talent either…I’m trying to be gentle.
So …of course I felt responsible to help him find new clients and would point others in his direction, when appropriate.

The above is the short version. The point is that through the therapists excessive self disclosure the therapeutic frame was irreparably damaged. The therapist had a professional responsibility to keep his “stuff” out of sessions. Of course he is a (very wounded) human being, but he should have been doing his own therapy and not exposing clients to his life’s desires and difficulties. This excessive self disclosure also created a “dual relationship” and it was one of the items in the licensing board complaint I filed. I didn’t “win” this part my case as the therapist denied that all of this occurred, and there really was no “hard evidence” to prove it…one of the problems with licensing board cases is the lack of hard evidence a client can provide. “Promotional” emails I wrote for him, to get speaking “gigs” and clients were “used against me” by his attorney in the “licensing board” complaint, as a claim that I had a great therapeutic relationship with him…B.S.! Again, I did what people pleasers and caretakers do. Therapeutically speaking, I transferred my childhood desire “to please and take care of” my parents onto him, in order to be accepted, and loved. Transferrence is a “normal” part of therapy, and a therapist must be capable of handling it appropriately…this therapist should have known, and in my opinion did know!

However, what he and I both know, is that along the “insurance fraud”, he commited, his excessive self disclosure and the dual relationship that was created, are the reasons therapy failed.

This therapist had a professional responsibility to reasonably “care for” me as a client and handle the transerence, and instead put himself and his needs first. In my opinion this therapist exploited my “weak points” and issues to serve himself.
Today, with the ongoing assistance of my current therapist, I am so happy to have realized that it wasn’t my responsibility to take care of and serve him.(and many others previously in my life).

A therapist has a professional responsibility to leave his stuff outside the therapy session!

Red flags of bad therapy#7 :Therapist takes on your spouse as a client and it’s not couples counseling!

Red flag #7: Your therapist takes on your spouse as a client and it’s not couples counseling

This is perhaps the biggest mistake I made in therapy! It arose out of caring, but ended up disastrous.

My now ex-husband had a substance abuse issue. After one of many nights of extreme “self indulgence”( as the therapist called it, I called it drinking to the point of extreme intoxication) and one of many nights of nasty fighting that he couldn’t recall, my ex-h once again laid claims to “wanting to get help”. At the time I had been going to al-anon for 6 months and seeing this therapist for about 3 months, but had never said anything about it to my ex-h. I had threatened divorce several times, but hadn’t committed to it, and was attending therapy with the hope of increasing my self-esteem, self worth and courage make a clear decision about divorce.

I explained to my ex-h that I had been seeing this therapist and thought perhaps the therapist could help him. I cared, and thought that perhaps if my ex-h quit drinking I could gain a better perspective on who I was really married to, underneath the self medication. I do believe my ex-h is a very sensitive person who lacks any sort of mechanism for coping with his emotions and feelings. However, I was not willing to engage in couples counseling with him unless he quit drinking first.. While substance abuse is involved in any relationship, therapy can not be effective for a couple until the substance is out of the picture. In my mind at the time I said “oh yeah, let me go to therapy with him on a Friday after work, then have him go to “happy hour” and when he comes home we can discuss what we talked about in therapy….not a sane idea!

So my ex places a call to this therapist and requests an appointment. I was in the group the therapist ran and at the end of it he tells me my then husband called, wanted to start therapy with him, and asked me ” If I was cool with it”. I said yes, PROVIDING his issues were his to deal with and mine were mine, that in no way was this to be couples counseling! If and when he could help him stop drinking completely, I would reconsider engaging in marriage counseling, and not before. I am 100% sure I made a clear statement about this.

However…after my ex-h started therapy suddenly I had to answer for issues that came up in my ex’s sessions with the therapist. It became ” ex-h said this and ex-h said that”. If I brought some fight we had up, it became “that’s not what ex-h said”. I was dealing with the distortions of an alcoholic through the “middleman” of a therapist”. (My ex’s sessions were on late Friday afternoons, and mine were typically on Saturday or Sunday mornings.) The therapist was making this marriage counseling without both parties in the room, and would frequently complain that “he didn’t know who was telling the truth”…again, I did not ask him to determine this! I was there to learn how to help and take care of myself.
What I got instead was my life and perspectives distorted by an alcoholic husband and a therapist who didn’t follow through with he agreement he made with me. I lost trust in the therapist and the therapy and should have “walked away” then and there.
In fact the therapist allowed my ex-h to share emails I had written and he had “hacked” into. A serious breach of confidentiality. I confronted the therapist on this and he didn’t seem to think he violated confidentiality, of course when I asked to share a phone message left on my cell phone by my ex-h, the therapist wouldn’t listen to it as it would be breaking his confidentiality with my then husband…..WTF!

At some point my ex absolutely refused to quit drinking, emphatically saying “I will not quit drinking”. So I filed for divorce.

This went on for the rest of my therapy with this therapist, even after the divorce, the therapist would ask how things were going with my ex, and if I said anything negative I was accused of “being the problem”

The therapist’s attitude was that whatever my ex said about me must be the truth and whatever I said about my ex was my own negative self projection! The therapist didn’t do this in the opposite direction. My ex’s words were “how it was”.

There are many more details to this story but they are a mute point.Bottom line is that the therapist should have known better than to have taken my husband on as a client. I would say it’s close to impossible for a therapist in this situation not to at least unconsciously “choose a side”, and entertain his own biases regarding marriage, relationships and perhaps his own paternalistic viewpoints.

On my end…I had the responsibility to walk away from the therapeutic relationship after explaining how I felt, and I did not. I stayed with it, if for no other reason than my past, which said “hey, I was here first” …something that goes back to having been the firstborn and having been “dethroned” by the birth of a new sibling. Not exactly a conscious cognitive memory! Yet those issues can influence our present day choices.

So that is Red flag #7 Your therapist takes on your spouse as a client and it’s not couples counseling!!!

BTW…My current therapist wouldn’t even consider taking on a friend of mine. In fact, would have to consider very carefully taking on anyone who was only even an acquaintance. This therapist maintains very clear boundaries, yet the therapy remains very open and very safe…and oh so refreshing and healing!