email page print pageAll Topic Reviews
Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBecoming MyselfBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExistential PsychotherapyExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning ACTLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulnessMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy East and WestPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe Trouble with IllnessThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
The conflict between legal methods of doing business and the aims of other professional disciplines can be a daunting morass for the individual trying to avoid a legal battle. Further, the imposition of the relatively inflexible and blunt instruments followed dogmatically and blindly in legal thinking upon another discipline has the potential to wreak havoc upon the proper provision of the non-legal duties required. This is nowhere more true than in the conflict between Psychotherapy and Law. William Reids A Clinicians Guide to Legal Issues in Psychotherapy enters this battlefield and purports to guide the psychotherapist away from legal danger in a little under two-hundred pages. Included among other topics in the guide are sections on clinical standards of care, consent, confidentiality and, importantly, model forms used in clinical and forensic practice. All is capped off with a glossary of legal terms. The prose is clear and simple, the sections are admirably brief and legal jargon is kept to a minimum. But can such a guide written to inform the psychotherapist so as to protect himself or herself from the grasping fingers of the legal profession be effective presented in such a compact volume? For instance, can the concept of standard of care, as understood in legal practice, be explained to the clinician in a chapter that is a mere twelve pages long?
Like many areas where the professional ideals of two divergent groups collide, the domain described as standard of care is a battleground where conflicting purposes must be somehow arranged. Reid, writing to keep the clinician as safe as possible from unwillingly entering into this battle within the legal practitioners territory without being well-prepared, outlines the concept of standard of care with a brevity characteristic of all the sections in the Guide. Not only that, but he analyzes multiple issues that arise within the legal concept of standard of care. For instance, one major question is when to realize that a duty of care has arisen. As Reid puts it even a simple telephone conversation or the making of an appointment might be enough . Situations from declining the patient before any therapist-patient relationship has been formed, to strategies on how to avoid abandoning a client after a therapist-patient relationship has been established, are investigated and strategies to help avoid legal liability are suggested. One issue rightly emphasized is the varying duties and levels of care that arise from different professional relationships between the client and the clinician due to such seemingly extraneous factors as employment status of the psychiatric professional. Further sections explain with minimal legal jargon that standards of care are defined by what reasonable practitioners in the same relationship would do, not by the individual practitioners own background. The existence of such an objective standard of evaluation is very important to be aware of. The fact that such a standard not only includes the required level of care and expertise but also requires the recognition of professional limitations  is also rightly emphasized.
The discussion of adverse and side effects of treatment is even more concise, encompassing a mere four pages. After distinguishing adverse effects - which are sometimes to be expected and tolerated as arising from treatment when the aim is a result that is important enough to risk the effect - from side effects, Reid lays out a four-part recommendation so the psychoanalyst will be meeting the standard for predicting, preventing, or controlling adverse effects, and/or mitigating their impact [p. 132]. The list offered reads: (1) proper recommendation; (2) adequately informed consent; (3) appropriate prescribing and/or application of the treatment; (4) appropriate monitoring and follow-up [p. 132]. Such a list has the appearance of being both mostly obvious as well as too brief to be of help. Is such an appearance true? Is such brevity helpful, or should more than a mere four pages be set aside for such sticky legal issues?
Actually, brevity here is a clear virtue. Reids aim is to help the psychotherapist avoid legal controversies. With such a purpose in mind a more nuanced and lengthy analysis of legal case law or statutes would be counter-productive. The need for subtle analysis would signal that the subject matter had strayed away from legally safe territory into areas where issues are still at least somewhat up for grabs. Anywhere where the issues are up for grabs is unsafe for the clinician to tread, and therefore territory that the professional trying to avoid involvement in legal procedures does not want to come near. Furthermore, due to the imprecise nature of legal processes and practices no amount of analysis, no matter how accurate or complete, will guarantee complete safety. Therefore, the brevity Reid accomplishes in his prose is fully warranted and the issues are properly treated at such a length.
More important than the individual chapter topics is a recurring message that is first raised in a section entitled Document, Document, Document [p. 12]. In this section effective strategies are listed in order to (no surprise) document the decision making procedures and reasoning processes utilized while attempting to properly care for the patient. The recurring message, though never quite stated as such, is make sure to force all the parties to tell your story in your own terms. As Reid does put it; Whoever started the rumor in professional circles that if you dont write it down, they cant hang you with it was dead wrong. In far more cases than not, complete, legible notes help clinicians whose care is questioned. Skimpy notes imply skimpy care . This is very important advice. Once in court the contest will very often come down to a question as to whose story of the event in question is accepted as true. Effective and thorough documentation helps ensure that the clinicians perspective is properly acknowledged and weighed. Decisions that were well-reasoned and adequate at the time they were made, given the unavoidable uncertainties and cost of further information, can appear questionable from a perspective informed by the knowledge of later undesirable results. Unfortunately such bad results may result even in the context of the most informed and competent decisions. A biased analysis due to analyzing past decisions from latter consequences has been labeled hindsight bias. Juries and judges have been found to fall into this form of mistaken or biased interpretation. The unfortunate result combined with the phenomenon of hindsight bias can effectively color an objectively reasonable decision made under adequate information to the point that from a later view the decision might look irresponsible or negligent. The only strategy effective in combating such a bias is proper and admissible documentation made at the time of the decision. Having this documentation available will ensure that the results involved will be properly balanced by a picture of diligence and responsibility under the circumstances. This pro-active defensive strategy ensures that the story told in court by the adversary grapples with the uncertainty of future outcomes as well as the diligent sorting out of reasons that the psychotherapist went through in choosing between care options.
Such a pro-active defensive strategy also helps ensure good clinical practice by making the decision process more explicit as well. Not only will the story-telling abilities of the opposing side be constrained by the documentation but just the availability of decent documentation signals diligence. A diligent professional cannot ever be certain to avoid unwanted legal controversy. But through being aware of legal trouble spots and properly documenting decisions as they are made, the clinician can make his or her chances of avoiding such an occurrence much better. A Clinicians Guide threads an unavoidable but perilous trail between overly technical legal analysis and the obvious or banal. The brevity of the book might seem to imply that the latter fault might have not been avoided. However, neither fault is found. Furthermore, the book succeeds admirably on its own terms. The expressed point of the work is avoidance of suits. A clinician that follows the advice contained in the book will certainly avoid more suits than one who thinks, for example, that no documentation is good documentation.
Brian E. Butler, J.D., Ph.D., Assistant Professor of Philosophy, The University of North Carolina at Asheville.
To buy this book from Barnes & Noble.com, click here