Advice for Practitioners and the New DSM
“Learn from the legal and ethical mistakes of others so you don’t have to repeat them.”
I became interested in law and ethics when a therapist, who was treating a family member, exhibited signs of countertransference. The experience was damaging to the family as a whole and it inspired me to research countertransference for my thesis and doctorate dissertation at the California School of Professional Psychology. During my research, I started to notice that therapists who had unconscious feelings about their clients got themselves into trouble with legal and ethical issues.
My own academic training inadequately prepared me to understand the complexity around legal and ethical issues within the field of psychology, even though law and ethics was covered heavily on my licensing exam. I took one 3-unit ethics class that emphasized morals and values related to issues like abortion. We didn’t talk about child abuse or specific requirements. I had to learn on my own.
Since then, I’ve written extensively about the implications of legal and ethical issues upon clinical work; acted as an expert witness for standard of care of practice for clinical psychotherapy; and led workshops at universities, agencies, and hospitals. Currently, I work with individuals and couples at my private practice in West Los Angeles, specializing in loss and grief, depressive and anxiety disorders, and quality-of-life issues.
Advice for Students and Practitioners
My advice for current practitioners is to “consult, consult, consult; and document, document, document.” Be careful of only consulting with people who provide you with the answers you want to hear. Professionals in the field should have a list of people to consult on the topic of law and ethics (not just colleagues who may be familiar with clinical issues). This includes seeking advice from a lawyer who can provide specific legal expertise.
I can’t emphasize enough the importance of students finding a specialty in the field of mental-health in order to gain expertise and marketability. I’d recommend joining an ethics committee which can lead to lucrative work as a consultant and an expert witness.
Implications of the New DSM
The new Diagnostic and Statistical Manual of Mental Disorders (DSM) presents mental-health professionals with new legal and ethical challenges, particularly as it relates to insurance reimbursement.
In my private practice I’ve faced clients wanting me to change my rate so they receive more insurance coverage, or asking me to change a less severe diagnosis to a more severe diagnosis so they are able to obtain insurance coverage. Even though some psychotherapists are willing to make these compromises, it is dangerous to do so. It is illegal, and it jeopardizes one’s professional license.
I believe all mental-health disorders designated by the DSM should receive a parity diagnosis and be eligible for insurance reimbursement. People of color, people in poverty, and those who are not seeing a psychotherapist in private practice often receive a parity diagnosis by default for insurance reimbursement. Thus, the current system shows these groups as having more serious diagnoses, which is not accurate.
I’m currently at work on a law and ethics textbook that addresses some of these topics in more detail, and I offer workshops and general ethics consultations to therapists in the field.
For additional information, visit drpamelaharmell.com.
My Recommended Resources
»»Join professional associations for networking and to stay current on changing laws, in particular: the California Association of Marriage and Family Therapists (CAMFT); the American Psychological Association (APA); the California Psychological Association (CPA); and the Los Angeles County Psychological Association (LACPA)
»»The Therapist magazine from CAMFT
»»Decoding the Ethics Code: A Practical Guide for Psychologists by Celia B. Fisher
»»Articles by Dr. Stephen H. Behnke, director of APA ethics office