What steps should a person take before committing to an alternative medical practitioner?
Talk to the ethics experts, and they'll tell you the best defense against an ethical problems is a good offense. By looking out for foreseeable conflicts and discussing them frankly with colleagues and clients, practitioners can evade the misunderstandings, hurt feelings and sticky situations that lead to hearings before ethics boards, lawsuits, loss of license or professional membership, or even more dire consequences. Show However, being vigilant doesn't mean psychologists should spend their days worrying about where the next pitfall could be, says Robert Kinscherff, JD, PhD, former chair of APA's Ethics Committee, which adjudicates ethics complaints. "Instead of worrying about the ways [they] can get in trouble, psychologists should think about ethics as a way of asking 'How can I be even better in my practice?'" he explains. "Good ethical practice is good professional practice, which is good risk management practice." When psychologists do end up in ethical quandaries, it's often because they unwittingly slid too far down a slippery slope--a result of ignorance about their ethical obligations or thinking they could handle a situation that spiraled out of control. Many problems are what Ethics Committee member Anne Hess, PhD, calls "stealth" dilemmas: situations that develop gradually, moving step by small step beyond once-firm professional boundaries. Although each step seemed harmless at the time, many practitioners later realize that they have landed themselves in deep trouble. The Monitor interviewed some of psychology's leading ethics experts to talk about how practitioners can avert common ethical dilemmas, from multiple relationships to whether to breach confidentiality, to terminating treatment. Here's their advice, boiled down to 10 ways to help avoid ethical pitfalls. 1. Understand what constitutes a multiple relationship Is it ethical to volunteer at your daughter's softball team fund-raiser if you know a client is going to be there? Can you buy a car from a client who owns the only dealership in your small, rural town? Can you ask an intern to drive you to the airport? "A central question in any multiple relationship situation is whose needs are being met here?" says Stephen Behnke, JD, PhD, director of APA's Ethics Office, which advises psychologists on ethical dilemmas. "Whenever the answer is the needs of the psychologist, that's a time when the psychologist needs to take great care and get a consultation." According to the Ethics Code, psychologists should avoid relationships that could reasonably impair their professional performance, or could exploit or harm the other party. Behnke emphasizes, however, that multiple relationships that are not reasonably expected to have such effects are not unethical. That's because sometimes it's impossible for psychologists to completely avoid multiple relationships, explains Steven Sparta, PhD, immediate past-chair of APA's Ethics Committee. For example, the psychologist in a rural town may decide to buy a car from his client because going elsewhere could signal that the car dealer was in therapy. How do you weigh the pros and cons in such situations? APA Ethics Committee member Michael Gottlieb, PhD, suggests in a Psychotherapy (Vol. 30, No. 1) article that psychologists think about three factors:
"It's only an ethical problem when there's a reasonable basis to see a foreseeable risk, and the psychologist fails to see it or ignores it and goes forth anyway," Sparta explains. Moreover, one type of multiple relationship is never acceptable: "Sexual relationships with current clients are never permissible," says Behnke. While sexual relationships with previous clients are not automatic violations of the Ethics Code if they occur more than two years after therapy's termination, "psychologists need to be mindful of the harm that can come from a sexual involvement with a client no matter when it occurs," Behnke adds. Lastly, if psychologists find that, despite their efforts, a potentially harmful multiple relationship has arisen, they are ethically mandated to take steps to resolve it in the best interest of the person or group while complying with the Ethics Code. 2. Protect confidentiality Psychologists are often asked to provide information about their clients to employers, spouses, school administrators, insurance companies and others. While such requests may be well-intentioned, psychologists need to carefully balance the disclosure with their ethical obligations to protect their patients' confidentiality. Indeed, because the public puts their trust in psychologists' promises of confidentiality, it's essential for psychologists to be clear on whether and why they are releasing information. "Ask yourself, 'On what basis am I making this disclosure?'" advises Behnke. "Is there a law that mandates the disclosure? Is there a law that permits me to disclose? Has my client consented to the disclosure?'" APA's 2002 Ethics Code stipulates that psychologists may only disclose the minimum information necessary to provide needed services, obtain appropriate consultations, protect the client, psychologist or others from harm, or obtain payment for services from a client. To help prevent confidentiality problems, psychologists can:
"If you wait and nothing bad happens, you've still violated the law," he says. "[But] if you wait and something bad happens, not only have you violated the law, but you have injured a potential victim who could have been protected." 3. Respect people's autonomy Psychologists need to provide clients with information they need to give their informed consent right at the start. When they fail to give details, sticky situations can arise. For example, when psychologists fail to explain their duty to report abuse and neglect to an adolescent client before therapy begins, they may be unsure what to do if abuse is later revealed that the client doesn't want reported. For psychologists providing services, the experts suggest they discuss:
If individuals are not competent to make decisions for themselves, then the person who's giving permission must have access to that same information. Moreover, a signed consent form does not substitute for the informing process, which should occur first, say ethics experts--and that includes situations where informed consent is implied,such as in an employee evaluation. 4. Know your supervisory responsibilities Psychologists may be responsible for the acts of those who perform work under their watch, whether it's interns providing therapy or administrative assistants helping with record-keeping and billing. That means supervising psychologists should continually assess their supervisees' competence and make sure they are managing them appropriately, say experts. Such supervision should cover everything from ensuring that supervisees conduct the informed-consent process correctly to prohibiting them from using the supervisor's signature stamp on any bill or letter that the supervisor hasn't reviewed. "If it goes out under your name, you're responsible," says APA Ethics Committee Chair Michael D. Roberts, PhD. "If they release medical files without proper consent, they're not going to sue the receptionist, they're going to sue you." According to the experts, supervisors should also:
5. Identify your client and role When practicing psychologists work with organizations or groups of individuals, they should understand from the start who they were hired to help and what is expected of them. Dilemmas crop up in a variety of settings:
How can psychologists avoid role-related dilemmas? "Knowing who your client is, what your role is and being transparent about what it is that you do and mindful about the professional boundaries that arise are good guideposts to effective practice," says Kinscherff. That means psychologists should, at the outset, have frank discussions with all parties involved about the relationship they will have with each person or organization--for example, are they hired by a business to enhance worker productivity or are they there to help individual workers with mental health problems? Other things to cover include confidentiality limits, what specific services will be provided to which people and how the psychologist and others could use the services or information obtained. "If you're reasonable and straightforward with people, treat them the way you would want to be treated in a similar situation, find out what their expectations are, and clarify those expectations, you'll be in good shape most of the time," adds Kinscherff. 6. Document, document, document Documentation can be psychologists' best ally if they ever face ethical charges, says Ed Nottingham, PhD, an associate member of APA's Ethics Committee. However, lack of documentation--or the wrong kind of documentation--can be detrimental. For specific guidance for practitioners, see APA's Record Keeping Guidelines. Some specifics to include in documenting therapeutic interactions, according to the guidelines and ethics experts such as Nottingham:
A few other tips:
7. Practice only where you have expertise Every psychologist knows they are obligated by the Ethics Code to practice only where they are competent. But sometimes difficulties arise when, for example, they practice in emerging areas where there aren't clear standards. "The problem is that, many times, how does the psychologist know when there's something they don't know?" says Sparta. "If you don't know from the professional literature that there are certain guidelines...you may be well-intentioned, but not realize you're going beyond the boundaries of your competence." Competence issues also come into a play in child-custody ethics, when psychologists are unfamiliar with the nuances of working with courts. Take the case of a psychologist who is asked to write a letter to a judge about the relationship of a boy in treatment to his parents. If she has little forensic training, the psychologist could land in ethical hot water if, for example, she failed to include the limitations of her opinion, such as that she's never met one of the boy's parents. Another area to keep in mind is assessment, says Campbell: "If you find yourself falling back on instruments because you feel confident with them and you don't know which others to use, that means you haven't kept up with the advances in that particular area and need to re-examine what needs to be done to be proficient." One of the best ways to address competence issues is to stay in touch with the profession through conferences, continuing education, seeking diplomate status, consulting with colleagues, and reading journals, guidelines and other publications, says Sparta. For example, if you begin seeing an adolescent with anorexia, but infrequently treat eating disorders, read up on the professional literature and arrange for supervision or consultation to ensure that the treatment is adequate. "In the age of long-distance telephone, teleconference and the Internet, it's hard to argue that you couldn't have gotten the right kinds of information," says Kinscherff. The 2002 Ethics Code does make exceptions for psychologists in extraordinary circumstances: Psychologists with closely related experience can provide services if there's no one else who can--as long as they make a reasonable effort to obtain the competence required. See Standard 2.01 for the details. 8. Know the difference between abandonment and termination Every year, APA's Ethics Office fields calls from psychologists who want to end treatment with a patient, but are anxious because they fear they're abandoning their client. "Abandonment is not the same as treatment termination," Behnke tells them, pointing to the 2002 Ethics Code, which says in Standard 10.10 that psychologists can discontinue treatment when clients:
Psychologists should provide pretermination counseling and suggest alternative service providers, says the Ethics Code, noting that this may not be possible in all cases, such as if a patient abruptly stops attending therapy. Such pretermination counseling could include explaining the benefits of the new services and why the current treatment is no longer helpful, addressing feelings of separation by emphasizing the transfer is not a personal rejection, and identifying practical issues in transferring the client, such as resolving financial arrangements with the new provider before ending treatment. "Involve the client in the plan," advises Sparta. "Empower them to feel confident and competent. Help the client understand that the transition is a constructive step toward achieving their goals." By contrast, abandonment occurs when a psychologist inappropriately ends treatment, such as halting needed therapy with no notice. In his tenure on various ethics groups, Sparta says he has seen as many cases when psychologists continued treatment beyond the point necessary as when they precipitously stopped treatment. While dependent clients can make it difficult to end treatment appropriately, the blurred multiple roles that can result from prolonged relationships--giving a client a job, for example--are too risky, says Sparta. Psychologists can often head off termination dilemmas by thinking ahead, say ethics experts. For example, a psychologist treats a woman until her insurance coverage expires, but when she can't pay out of pocket, he explains that the relationship must end and facilitates her care to another provider. To avoid the misperception that the psychologist "dumped" the client, the psychologist discusses the treatment timeline at their first session, including the differences between short- and long-term therapy and what could happen if therapy was needed beyond what the woman's insurance covered. If there are cases in which it's apparent that a patient may have financial troubles at therapy's start, give consideration before you take the case, say ethics experts. And make sure you are aware of clients for whom financial hardship is developing. 9. Stick to the evidence When you give your expert opinion or conduct an assessment, base your evaluation only on the data available. For example, psychologists in child-custody cases should be sure they aren't being biased in favor of the parent who is more financially secure. "The best approach is to stay mindful about what you know, what you don't know and what your sources of information have been," says Kinscherff. Ethics experts recommend that psychologists:
10. Be accurate in billing There's nothing more important than accuracy when it comes to billing patients and insurers for psychological services, say ethics experts. While sloppy bookkeeping can land some psychologists in hot water, others find themselves in predicaments because they've worked the system to get clients more benefits than a third-party payer entitles them to. To avoid such ethical problems, a psychologist should:
"Be accurate, conservative, and consult when in doubt," advises Ethics Committee associate Peter Mayfield, PhD.
Lastly, there's one, best strategy that psychologists can take to minimize their exposure to ethical and legal problems, says Behnke: "Be the best psychologist you can be." How do you convince someone to use alternative medicine?Do ask, they'll tell. The first and the most important point is asking patients if they are using herbs or natural health products or visiting an alternative practitioner. ... . Explain the science. ... . Be respectful and nonjudgmental. ... . Collaborate. ... . Compromise and negotiate.. Why should one be aware of the alternative healthcare modalities?Natural/healthy approach. Alternative medicine is all about re-harmonizing your body on your body's terms. Using natural substances like herbs and oils, alternative medicine is gentler than traditional medicine and typically doesn't cause side effects that damage your body.
What is an alternative approach to health?Complementary and alternative medicine includes practices such as massage, acupuncture, tai chi, and drinking green tea. Integrative medicine is an approach to medical care that combines conventional medicine with CAM practices that have shown through science to be safe and effective.
Which is an example of an alternative medical practitioner?Traditional alternative medicine may include:. Acupuncture.. Ayurveda.. Homeopathy.. Naturopathy.. Chinese or Oriental medicine.. |