This workshop is for Virginia psychologists. It is based on an Ethical/Legal Practice Manual, written by Dr. Fisher and published by the Virginia Academy of Clinical Psychologists (VACP), which integrates the APA Ethics Code, Virginia Board of Psychology Practice Standards, Virginia Statutes, and Federal HIPAA Regulations. (This website also contains an order form for the 2010 Edition of that Practice Manual.)Details >
Whose advice are you hearing as you develop your policies for clinical practice? Who are your ethical models for deciding how to handle such important things as billing for third party reimbursement, clinical boundaries, or informed consent? What policies protect your clients in the “dual/multiple relationships” of couple/family cases? What is your policy about disclosing information if you don’t have the client’s explicit consent?Details >
- The Ethics of "Conditional" Confidentiality
The book “The New Informants,” by Christopher Bollas (psychoanalyst) and David Sundelson (attorney) created quite a stir when it was published in 1995. Today, few people mention that book. But it is worth revisiting. It contains important information we should all be aware of; it offers admonitions we should still consider; and it makes some claims we [...]Details >
This workshop considers some of the ethical implications of the presence or absence of clear policies about fees, billing, availability, absences, emergencies, confidentiality, disclosure, boundaries, etc. (1) How clear should they be? (2) How should they be described to clients? (3) How well are they understood by others that you work with who implement them in your setting, including clinical and non-clinical staff, as well as by those you train, mentor, or supervise?Details >
This is not a risk-management workshop. But we know that sometimes making exceptions to our usual ethical and clinical practices can start us on a path from which it can be very hard to recover, and which can ultimately affect clinical outcome and patient welfare. How can we recognize when we are about to take a [...]Details >
What are our ethical and legal responsibilities as we begin a clinical relationship?Details >
What are our ethical and legal obligations when ending a relationship?
How can the beginning help to create a better ending?
How might a “professional will” protect clients in the event of unexpected endings?
This all-day workshop explores some of the pitfalls that can arise when beginning and ending clinical relationships. With good planning, many of those are avoidable; but we will also explore ways of preparing for the unavoidable ones.Details >
This workshop involves little formal presentation of information. We will use your experiences and hypothetical case situations, and we will arm you with handouts of your ethical & legal standards, in order to practice using an Ethical Problem-Solving Model to resolve ethical and ethical/legal dilemmas.Details >
- Ethically, What Is The Difference?
Ethics writers are asking us to make a distinction between a benign non-sexual “crossing” of boundaries and a harmful unethical “violation” of boundaries in client relationships. What are the ethical and clinical implications of that distinction? Where should we draw the line? Who gets to decide?Details >
This workshop considers the ethical and legal complications that arise because confidentiality is “conditional” rather than absolute, using an Ethical Practice Model that prepares therapists to explain the expectable “limits of confidentiality” and to protect patients’ confidentiality rights.Details >
What are the ethical implications of how we handle encounters with clients or their families outside the clinical setting? How do we decide where to draw the line in such encounters? Are there any ways to minimize their occurrence, or to prevent unnecessary clinical complications? How can we prevent them from becoming problematic dual relationships?Details >
- A Step-By-Step Guide to Ethical Decision Making
This workshop will introduce several ethical decision-making models and will use hypothetical case vignettes to illustrate how they might be used in various settings. Participants can practice using them in preparation for adopting one for use in their own practice or when supervising, training or consulting with others.Details >
- Why Is "Who is the Client" the Wrong Ethical Question?
What Ethical Question Should We Ask Instead?
We are often advised to ask “Who Is The Client?” when determining our role or clarifying our confidentiality rules in cases involving multiple clients or agency referrals. But that question implies a singular answer, which can create more problems than it solves! “Who is the client?” may be a required reimbursement question; and sometimes it is a helpful clinical question; but as an ethical question, it can lead us astray.Details >
This workshop is based on Dr. Fisher’s 2009 article, “Replacing ‘Who is the Client’ With a Different Ethical Question, published in Professional Psychology: Research and Practice, 40 (1), 1-7.
This workshop includes a brief review of what “Confidentiality Ethics” requires us to know; but it is mostly about what we should be trying to DO with what we know. Beyond protecting the confidences of patients/clients, what other ethical, legal, clinical, and practical steps will help us carry out our broader professional obligations about confidentiality?Details >
When working with couples in therapy, certain policies and practices can predictably create ethical dilemmas &/or lead to legal complications. Couple therapy is difficult enough without adding unnecessary complications. This workshop is designed to help you anticipate, prevent, and/or minimize risks to clients – and thus to yourself.Details >
Ethics Codes specify that not all dual relationships are unethical. When must we say “no?” When do we have no choice? When are we free to say “yes?” Before we voluntarily create a dual relationship, or if we enter one “involuntarily” because required by law or by agency policies, what are our ethical responsibilities for evaluating/anticipating the potential for harm – or the perception of harm?Details >
What are our ethical and legal responsibilities if a client threatens harm to others? What is the difference between a legal “duty to warn” and a legal “duty to protect”? Which of these applies in Virginia? In addition to cases of threats of harm, what are the other circumstances when Virginia clinicians have a legal duty to disclose information for the protection of the client or of someone else? How closely do our profession’s ethical responsibilities coincide with our legal obligations under Virginia law?Details >
How Many Hats Do You Wear?Details >
Where Do You Draw the Line?
This workshop explores these two inter-related issues that are often confused with each other, and which can create ethical dilemmas for clinicians.
What do our Ethics Codes have to say about relationships with colleagues? What ethical complications might arise in collegue relationships, whether in consultations, case referrals, or other collaborative situations? What are our ethical obligations if we believe a colleague’s behavior is putting clients at risk? How well do our Ethical Standards fit together with Virginia’s laws on these matters?Details >
Ways of Organizing Essential Ethical & Legal Information This workshop is designed to review and organize the broad range of ethical and legal information that mental health professionals are responsible for knowing. Categories must encompass ethical topics such as those below & must also reflect legal sources of information about those topics from state and [...]Details >
A workshop for clinicians who provide consultation or supervision, but also appropriate for those who receive consultation or supervision. Learn the importance of structuring the relationship in advance: informed consent. Learn the responsibilities of supervisees and consultees, as well as those of supervisors and consultants.Details >
When working with multiple-party cases, some specific ethical and legal issues must be considered. Therapists who proceed without careful forethought and advance planning may be in for some ethical pitfalls down the road. INTRODUCTION: Ethical Implications of How We Conceptualize a Couple or Family Therapy Case I. “What Are My Ethical Responsibilities to Each Party in [...]Details >
- Clients' Rights & Therapists' Ethical Obligations
This workshop considers the ethical and legal complications that arise when confidentiality is “conditional” rather than absolute. How clear are your policies about exactly what you plan to disclose to whom — and when? How ready are you to describe those policies to patients and answer their “what if . . . ?” questions?Details >
What are the ethical and legal implications of transmitting client information electronically via computer or FAX; storing client information on computers, laptops, external drives, or disks; communicating with clients via email, twitter, or other electronic formats; using mobile phones or other portable communications devices; interacting with clients on facebook or other social network online sites? What [...]Details >
For mental health professionals who provide assessment services, there are some specific ethical considerations. This is true whether they are in a private practice, in an agency or school setting, or within a forensic setting. OUTLINE 1. Ethical Standards 2. Competence – Acquiring It & Maintaining It Personal Competence Professional Competence Using Up-to-Date Tests & [...]Details >
- Anticipating & Responding to Ethical Dilemmas
A workshop about facing the problematic ethical aspects of clinical practice, reducing the risks to patient and clinician by avoiding the avoidables, and using an Ethical Decision-Making Model to resolve the unavoidables!Details >
This workshop is structured as an interactive advanced seminar: You bring the “hypothetical” temptations. We provide an Ethical Decision Making Model to help us practice responding to them.Details >
Ethical-Legal “Jeopardy!” (Who Said Ethics Was Boring?) The first half of this workshop is an overview of some simple, basic topics in professional ethics and Virginia law. The second half of the workshop will be conducted a bit like a “Jeopardy” game. Using the categories below, we will test our understanding of what we have [...]Details >
Respected ethicists suggest that clinicians should consider all the options when faced with a legal requirement that conflicts with their ethical standards. Do we recognize ethical-legal conflicts when they arise, or do we fail to face them for what they are? If you must choose, should you follow your ethical standards or obey the law? What happens if you choose to disobey the law?Details >
Following Your Own Ethical Compass: Avoiding Law-Based Mindsets, Risk-Management Mindsets & Anxiety-Based Behavior We waste a lot of energy and create a lot of unnecessary anxiety when we adopt a solely risk-management position, because it leads us to focus on on possible risks to ourselves. Instead, we must give priority to an ethics-based mindset which leads us [...]Details >
Forethought is sometimes considered the single most important aspect of ethical practice. Knowing the “ethical rules” is very necessary, but it is not sufficient for avoiding ethical dilemmas. With forethought and planning, however, many ethical dilemmas are actually avoidabole. How well can we avoid receiving subpoenas, prevent misunderstandings about fees and reimbursements, eliminate the confidentiality confusions in multi-client (couple/family) therapy? This workshop is about anticipating such ethical dilemmas, avoiding the ethical complications when avoidable, and being prepared to meet the ones that are unavoidable.Details >
Ethically, it is important for mental health professionals to do good without doing harm (i.e., to practice both beneficence and nonmaleficence). In this workshop we will consider ways of meeting this ethical obligation, but also consider the importance of balancing this care of patients with ongoing self-care that prevents harm to self.Details >
When it comes to privacy and confidentiality, how do the legal standards (Virginia state laws and regulations, or federal HIPAA regulations) compare to the Ethical Standards of our own profession? How can we integrate these overlapping requirements? If they impose conflicting obligations, what do our Ethics Codes say about how we can resolve the ethical/legal conflict? NOTE: This workshop is not intended to serve as a substitute for formal HIPAA training.Details >
We say this when dealing with an outcome we could have avoided if we had sought more information, been more forethoughtful, or consulted before acting. Dr. Fisher will share examples of such situations from her own practice and elsewhere, in the hope that this will help others be better prepared. Attendees are invited to add to the agenda [...]Details >
- Integrating the APA Ethics Code, Virginia Law & HIPAA
This workshop for psychologists reviews the informed consent requirements in the 2002 APA Ethics Code, Virginia law, and federal HIPAA regulations. After providing a framework for integrating them, clinical vignettes illustrate how informed consent requirements might apply in different types of cases.Details >
Informed consent is a process, not a one-time event; and that process can become complicated with couples and families. We will review both ethical responsibilities and legal considerations to answer questions such as:Details >
Who must be informed? About What? When?
From whom must we obtain consent? For what? When
At the initial session, what topics must we cover and whose consent must we obtain?
After the initial understandings, when must the conversation be reopened?
This workshop is based on discussion of ethical issues raised by clinical vignettes such as those below, adapted and used used with consent from a state psychological association. Others sources will also be used. Dilemma 1: Therapist in the Middle Dilemma 2: A Suffering Caregiver Dilemma 3: A New Referral? Dilemma 4: A Therapist in Turmoil Dilemma 5: A [...]Details >
- Have Our Rules Changed?
This workshop for psychologists provided a detailed discussion of the changes in their Ethical Standards. Participants received copies of their new 2002 Ethics Code.Details >
- Ethical Implications of New and Amended Virginia Laws
We offer this workshop whenever there are important changes in the Virginia laws and regulations that affect mental health professionals. Some years bring more important changes than others. As an example, we provide here the outline of one of our workshops about the 2008 legal changes, most of which were precipitated by the tragedy at Virginia Tech.Details >
Clinicians in every state must follow both their profession’s Ethical Standards and their state’s laws. How well do Virginia’s laws fit together with your Ethical Standards? What ethical issues might arise for clinicians under Virginia’s specific combination of laws?Details >
- Ethical & Practical Implications of Provider Contracts
Each provider contract you sign will have slightly different terms; each managed care company will have different policies and impose different limitations. We will review some implications of various written and unwritten understandings, consider their ethical implications, and use case excmples to discuss how we can avoid some of the potential ethical pitfalls.Details >
- Ethical, Professional & Business Aspects of Running an Independent Practice
This all-day workshop first covers ethical, legal, and personal issues that can affect business decisions, then provides a process for clarifying and expanding your own business plans.Details >
[NOTE: CE credits are provided only for the morning (ethical and legal) portions of the workshop, not for the business portions.]
- Ethical & Professional Implications of
Financial Decisions in Mental Health Practice
This workshop is about an area of practice neglected in graduate training programs and still treated in some circles as a “taboo” topic for therapists and other mental health professionals. It is appropriate for any mental health professional who is in (or is planning to be in) independent practice, whether individual or group. It also [...]Details >
- (Couple, Family, Group, Child+Parent, Individual With Collateral Participant)
When providing multi-client therapy — couple, family, or group therapy; child therapy with parent consultation; or collateal participant in an individual adult therapy — certain ethical, legal, and/or clinical dilemmas often arise. Are you avoiding the predictable dilemmas and preparing clients for the “unpredictables”? Do you remember that “clinically interesting” is not synonymous with “ethically appropriate”? This workshop is designed to help clinicians anticipate, prevent, and/or minimize the risks to clients — and thus to themselves — when providing therapy in multiple-client configurations.Details >
There is much discussion about diversity and “multicultural competence;” but often there is little specificity about definitions. Exactly how do our professions define “multi-cultural”? If we speak only one or two of the 337 languages used in the U.S. today, does it count if we are proficient with patients from rural cultures? from certain disability groups? [...]Details >
Certain categories of patients create difficult ethical dilemmas for therapists. Using information from the research literature, as well as our own experience of various types of patients, how can we anticipate the predictable dilemmas, avoid the avoidable ones, and respond ethically to the “unavoidables”? I. Potential Pitfalls & Ethical Dilemmas With Various Patients Depressed Anxious/Fearful [...]Details >
- Avoiding Ethical Pitfalls in Clinical Endings
This workshop addresses questions such as these:Details >
What ethical and legal issues can arise around clinical endings?
What should we consider when planning terminations?
With forethought, can we avoid the ethical pitfalls that arise from unplanned terminations?
What is the difference between “therapist-initiated termination” and “abandonment” ?
What provisions should therapists make for their own unexpected absences?
How have our professions’ Ethical Standards changed across time?Details >
How have we reacted to those changes?
How does our personal and profesasional development affect the ways we approach ethical issues or change the types of ethial dilemmas we are more likely to notice, encounter, or create?
- Ethical Implications of Our Inevitable Loyalty Conflicts & Conflicts of Interest
This workshop explores some of the loyalty conflicts and conflicts of interest inherent in clinical work and considers ways of reducing their impact. We will explore ethical, legal, clinical and personal implications of denying them or failing to explain them to patients, as well as resources for helping us respond to them.Details >
- When May you Disclose Client Information?
When May You Refuse to Disclose?
When MUST You Refuse to Disclose?
This workshop is based on a 6-step Ethical Practice Model that integrates ethical and legal obligations about confidentiality and guides decisions about disclosureDetails >
- With Access to Patients and Their Data, What Should Employees Be Taught?
Offered by popular demand, this workshop is appropriate both for clinicians and for their employees or contracted agents (e.g., billing agents). [Fee is discounted if employer and employee attend together.] Employee training rarely includes formal discussion of professional ethics. Yet, clinicians are ethically and legally responsible for the actions of their staff. HIPAA now requires “workforce training about how to protect patients’ privacy/confidentiality rights as legally defined by HIPAA. We recommend a broader ethical/legal training for all non-clinical personnel with access to patients and their data (and also for clinical supervisees, students, interns, and volunteers), in order to better protect patients and their rights . . . and you. Participants leave with a sample staff-training manual, on paper and on CD.Details >
This workshop focuses not on the “ethical floor,” as defined by the ethical mandates in each profession’s ethics code, but instead on the “ethical ceiling” as defined by individual mental health professionals. Discussion will include issues such as how personal values fit into the ethical equation; ethical options if one’s personal values conflict with formal ethical standards; and ways of defining and striving toward one’s personal “ethical ceiling” as a mental health professional.Details >
What guidelines should we follow for developing our policies about clinical records?Details >
This workshop covers some of the ethical, legal, and practical considerations.
In the midst of worrying about the record-keeping reuirements imposed by state laws, HIPAA, managed care contracts, agency policies, etc., and with our eye on liability, are we losing our ethical perspective? We will cover ownership, content, storage, retention time, and other practical issues, but our primary focus will be on the ethical considerations that should underlie our decisions.Details >
This familiar question asks for a singular answer. That may be important as a clinical or legal question, and it is sometimes required as a reimbursement question. But as an ethical question, it is misleading and problematic. It is important for you (and for those you supervise) to understand why a better ethical question is: “What are my ethical obligations to each of the parties in this case?”Details >
Does our language about informed consent create confusion about it? Therapists and other mental health professionals often ask how they should “deliver” or “give” informed consent to patients. But in fact, informed consent is something you receive — “consent from an informed patient.” This workshop lets us practice fitting our language to the concept as [...]Details >
- Ethical and Professional Implications of Burn-Out, Stress, & Self-Neglect
Our ability to take care of ourselves as professionals has a direct impact on our objectivity and competence in caring for clients. Similarly, clinical work affects our own personal, emotional, and spiritual life. We approach this topic from both perspectives as we consider the ethical, clinical, and personal importance of self-care.Details >
This workshop is structured as an interactive advanced seminar. Participants bring the “hypothetical” ethical dilemmas. We provide handouts of ethical and legal resource materials and an Ethical Decision-Making Model with which to practice resolving the dilemmas.Details >
What is the legal difference between an attorney-issued “discovery subpoena” and a judge’s “court order” to produce information? What are the ethical implications of this legal difference? Can you file a “motion to quash” a subpoena? Should you? Will you agree to be an “expert witness” or only a “fact witness”? Deciding how to answer these questions will be important in preparing to protect the rights of any client who becomes involved in a court case.Details >
*This workshop uses a Practice Model adapted from Fisher, M.A. (2008). Protecting confidentiality rights: The need for an ethical practice model. American Psychologist, 63, 1-13. doi: 10.1037/0003-066X.63.1.1 and Fisher, M.A. (2013). The Ethics of Conditional Confidentiality: A Practice Model for Mental Health Professionals. New York, Oxford University Press. ISBN 9780199752201 INTRODUCTION: The ABCs of “Conditional” [...]Details >
Therapists have many different opinions about self-disclosure with their patients. But regardless of your theoretical orientation or type of service, are there certain types of self-disclosure that are likely to be inappropriate in clinical relationships? We will explore the possibilities and test their potential consequences to the clinical process. I. Ethical & Professional Guidelines [...]Details >
Where do our professional duties end and our patients’ responsibilities begin? In this workshop we will focus on some of the ethical dilemma that might raise this question. For example, if a patient needs hospitalization, what scales do we use for balancing the ethical principle of beneficence against the duty to foster patient autonomy? What [...]Details >
Are you clear about the distinctions reflected in the list below? Why it is ethically important to understand these differences? How might patients/clients be harmed if you fail to do that? What might be the risk to you if you fail to do that? 1. Personal Moral Code vs. Professional Ethics 2. Ethically-Required vs. Ethically-Permitted Behavior 3. [...]Details >
- Exploring Some Ethical & Professional Implications of
Available Roles for Mental Health Professionals
Our professions, and others in the marketplace, are encouraging us to explore new ways of using our clinical skills — new roles, populations, & venues. We will explore some of the new forensic-related roles, technology-assisted roles, and innovative interventions. What are some of the ethical and legal implications of the roles now suggested to mental health professionals? How will we decide whether and how to acept them?Details >
- Integrating Ethical Standards & Laws
Ethics Codes have some important things to say about minors’ confidentiality rights, but how do those fit together with the legal provisions in Virginia statutes? Because Virginia law gives minors of any age the right to consent to outpatient treatment, HIPAA regulations therefore give Virginia minors almost the same rights as adults; but what are the legal limitations of those rights (e.g., Virginia’s statute granting parents access to minors’ records)? How does all this legal information fit together with our ethical standards? This workshop represents our best attempt to integrate all these ethical and legal mandates.Details >
- What Are Your Ethical Responsibilities When Entrusting Tasks to Others?
Do others serve as “on call” clinicians for you? Do you use clerical staff, a billing agent, an answering service, a computer guru, etc.? Do others participate in interviewing your clients or obtaining signatures on consent forms? Do you have assistants who administer or score tests? Ethics Codes impose some specific obligations when we entrust tasks to others. HIPAA also imposes legal requirements if those delegated tasks involve interactions with clients or with their protected health information. This workshop summarizes the ethical and legal obligations and considers their practical implications.Details >
- Raising the Ethical Issues We Avoid
Some ethical issues are difficult to address, so we clinicians tend not to raise them in supervision, consultation, peer conversation, or workshops. Dr. Fisher will dare to put some of those on the table, using clinical case vignettes. Participants are invited to share any “hypothetical” case situations they choose, but no one will be “put on the spot” or required to raise personal examples of the issues she will present.Details >
- Ethical Pitfalls, Legal Rules, & Confusing Roles
Whether you provide records or testimony voluntarily or involuntarily, some important ethical standards and legal rules will apply. Things become even more complicated if you are not clear in advance about your role(s).Details >
Mental health professionals take on many different roles and provide many types of services. Your ethical responsibilities will vary, depending upon your role at the moment. How does the ethical equation change if you are in more than one role at a time? Which role combinations are most likely to cause ethical complications, and can [...]Details >
As of July 1, 2008, Virginia has some new laws, several of which were enacted in response to the Virginia Tech tragedy. How might they potentially affect your clients? How might you need to change your promises about “limits of confidentiality?” In 2008, the Virginia Legislature passed laws which may affect your practice regardless of [...]Details >
Which practice areas create ethical or legal difficulties for mental health professionals? Why?Details >
What pressures lead us to make poor ethical decisions?
What can we do about it?
What ethical obligations are specific to the hat(s) you wear? Certain basic ethical responsibilities apply across the board — regardless of our role — but some roles bring with them specific additional ethical obligations. This becomes even more complicated when we multiply hats.Details >
How we conceptualize, define, and explain “client” can sometimes have wider consequences than we expect. This workshop is designed to explore some of the ethical, clinical, legal, contractual, and financial implications of how we answer the question, “Who Is The Client?”Details >
Appropriate for any mental health professional who works with minors in any setting, this workshop will cover some of the ethical and legal basics, plus some of the complications created by Virginia statutes and court cases.Details >
- Ethical & Legal Issues for Therapists
Do our Ethics Codes have anything special to say about working with families that are separating, facing divorce, or already divorced – or about working with families facing contested child custody issues? Does Virginia law have anything particular to say that affects how we work with these families, or what we explain in advance about our roles and our policies about confidentiality? Are there particular ethical or legal risks for therapists who work with members of these families, and if so, how can we avoid or minimize these risks?Details >
Most clinicians see some elderly patients and/or work with their adult children. This workshop is appropriate for therapists and other mental health clinicians of all professions in all settings, and for clinical graduate students.Details >
Working with college students can raise important ethical issues when making decisions about such things as client autonomy, confidentiality, and informed consent. This workshop also looks at some of the ethical issues that can arise because of Virginia’s current laws. A. ETHICAL ISSUES WITH STUDENT THERAPY PATIENTS Informed Consent Confidentiality & Its Limits Ethical/Professional Duties College/University Policies Legal [...]Details >