Question: Is it good practice for a psychotherapist to fill in paperwork for third parties such as insurance companies or service records while having a therapy session with the client? My therapist spends more time looking at his laptop than at me and he asks me questions that have very little to do with my concerns because he needs the information for his forms.
Answer: I am a therapist in private practice and the executive director of a substance abuse agency so I have looked at this issue from both perspectives.
I think it is unethical and bad practice to make notes for the record to comply with regulatory or payor requirements unless the client/patient is requesting it.
The whole ethical question of who the therapist is really working for comes to the foreground. As a Licensed Clinical Social Worker I have been taught that my primary ethical commitment is to my client not to some third party unless there is a clear understanding with the client that I am seeing them at the behest of the third party and that the third party is calling the shots regarding the services I am providing to them.
I find patients and health care providers these days very confused and conflicted about who is really dictating the format and protocol for the services being delivered to the patient. Unfortunately, in most cases it is not the patient.
I don't think that keeping records for a third party while I am engaged in a therapeutic conversation with a client constitutes good care let alone ethical care unless the client agrees that third party agendas can be pursued while services are being provided to him/her.
I concur. Have you confronted him about it? He's working for you, after all.
ReplyDeleteThe times when I've been to appointments and the doctors has been taking notes, it's been really distracting. Even if s/he is able to pay attention (or can appear to), I find myself wondering what the heck they are recording...is it about me? Something I said? Is it bad?
ReplyDeleteOver at the website I help out on (speakhealth.org) we examine issues about the relationship between health care providers and patients, among other things. A lot of people- most, in fact- have real misgivings about being honest with their problems, for a plethora of reasons, fear of being judged not the least of them. I understand that for therapists, it is sometimes necessary to follow these procedures, but i think it will exacerbate the problem of mistrust and unease amongst patients
~caroline
Caroline:
ReplyDeleteThank you very much for your comment. I think you are absolutely right that patient's find it unnerving that providers are paying more attention to their forms and/or computer than they are to them. Also, wondering what is so important that they are recording about me, is another cause for concern.
All the best,
David Markham