Seeking input about an issue that came up in practice

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I'm a student. I do my best to operate by the family rule. If I'm not treating the patient as though they were my own family or advocating as though they were I'm not doing my best.

I wouldn't want my family to be seen by this person. She has proven to no one that she is capable or competent to a societal recognized standard. Report her to any of the medical or psychology boards. Or even file a complaint with the local police. Let those organizations be the one to figure it out.

She has no respect for the people who lawfully fill that roll. That makes me doubt she respects the privileges/duty/obligations that come with it. Therefore, she isn't fit to continue masquerading as such.
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Well, not to waste too much time defending this woman, but she isn't technically masquerading as something she is not. If she were claiming to be licensed or claiming to be a psychologist, LPC or social worker, then I would definitely be reporting her to the appropriate board. So far as I know, she is not and therefore the lawyers have told me that she isn't reportable to anyone, that what she is doing is legal, and that my only decision now is how comfortable I am with that. They also advised me to notify them immediately should I learn that she is putting herself out there as a licensed somebody.

Now having said that, while she didn't lie to me, she definitely was not immediately forthcoming with the truth, which I do not at all appreciate and which definitely plays into this overall "comfort level" that I am supposed to be determining.

So this is where I am now:

1. I am definitely not doing the supervision group.
2. I am not taking referrals from this woman any further (and needless to say, she will get none from me. She hadn't yet in any case because even while I thought she was licensed, I didn't think she was that great.)

3. What to do with her patients I already see, of which there are three --all of which are scheduled within the coming week. I think I might take the advice someone offered above. In that I will have a conversation with these three people and say that I have learned that their "therapist" is not licensed. I will say that I am not comfortable working with unlicensed providers in a collaborative relationship because of the liability risk. This is so for ALL unlicensed providers and I have nothing bad to say about their particular one. I will continue seeing them, if they desire, but for legal reasons I will not consider what they are getting from her to be qualified psychotherapy. She will be considered as someone they talk to from time to time, the same as a friend or a guidance counselor or the like. If they are unhappy with this, they can stop seeing me with no hard feelings. They may return to their previous psychiatrist or I will give them the numbers of some others. I will also be happy to refer them to a licensed therapist with whom I will be happy to work collaboratively. Also, I may at some future point insist on a referral to a licensed psychotherapist if I feel that their "issues" are sufficient to warrant it. Refusal to do so at that point might result in d/c for non-adherence to recommended treatment.

Does that sound reasonable?
 
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I was at a workshop today and talked to a few more people and this is actually what I am going to do:

I will talk to this woman's patients when they come in for their appointments and tell them that their therapist is unlicensed. I will tell them that I cannot work with unlicensed people no matter how good they are (and I will not roll my eyes at that piece, but I will be thinking it) because it puts me at risk liability-wise.

I will then say that they are welcome to continue seeing her, but I will not be working in collaboration with her and that furthermore if they continue to see me, they will also have to see a licensed therapist. So their options become:

1. Seeing me, seeing English major AND seeing someone licensed
2. Seeing me and a licensed therapist
3. Seeing their English major and not me.

I'm not going to offer to provide therapy myself both because I want to avoid appearance of "stealing" this woman's patients and also because I don't want to. I don't want be the one to undo all the years of crap working with this woman has probably left them with. I will provide phone numbers for other therapists if they decide to go that route and for other psychiatrists, if they don't. With the warning that they might run into this issue again with other psychiatrists.
 
Thorny issue, but it sounds like you made the right decision. I really wish the licensure laws regarding "therapy" were more clear...it really is a mess out there. Though I suppose I can understand it, relative to many other health-field activities (e.g. writing a prescription, taking vitals, etc.) defining "therapy" is a lot more difficult. Many people in all kinds of health-related fields are asked for advice about personal problems. True psychotherapy and "advice giving" are two very different things, but I'm not sure its possible to draw a clean line separating the two. I suspect this is why there are so many legal issues related to it.

To follow up on erg's comment about the psychologist being unlicensed...I feel like the laws are so unclear I'm not sure what could be done. APA can't do anything other than kick them out of APA. I'm not sure how licensing boards would handle it unless this person was calling themselves a "psychologist". I'm not sure having the degree is an issue by itself, unless the degree is hanging in the office. I don't understand the details, but I know this gets even more complicated in research settings. At least in my state, you can definitely still do psychotherapy as part of a research protocol even without a license, though you can't be involved in primary clinical work. In other words, people can run treatment research in their labs, but can't provide supervision in the clinic. Given the incredible amount of bureaucracy IRBs and the government have set up that causes problems with research, I don't understand how this is possible.
 
Well, apparently this woman was calling herself a life coach. I saw the first of the three shared patients on Monday. I called the "therapist" on Monday morning and left a message on her voice mail outlining what I was going to do and also expressing my disappointment in her obfuscation of what the group was really for. I also invited her to call me back if she wished to discuss it. She did not. So I told the patient the situation. I told him I had nothing personal against this woman, but that it was a liability decision for me on the advice of lawyer types. He was aware she was unlicensed, but thought she was under the supervision of the psychologist in the office. To my knowledge, she is not. That's why they wanted ME. He also said, "She said she's like my 'life coach.'" He wanted to continue seeing me and was actually willing to see a licensed therapist in addition to this woman. I gave him the name of an LCSW and a PhD psychologist who work in the neighborhood right where this guy lives. "Will they take my insurance?" He wanted to know. He is a Medicaid patient so I told him that I knew the LCSW takes medicaid, but that I wasn't sure about the psychologist, but it was worth a call to ask. He did call the LCSW and left a message on her office voicemail. I know this because she told me. He then called later the same day before she'd had a chance to call him back and stated that he wasn't interested in seeing her after all because of "financial reasons." No clue what those would be. He'd be seeing her all expenses paid by Medicaid. They don't even have co-pays.

Then yesterday, patient #2 calls and says his therapist told him that I would no longer be working with her group. "Can I still see you?" He asked. Yes, I said, but we needed to discuss certain parameters, but we could do that at his appt which was scheduled for this Thursday. He agreed. He called back later and said he needed to cancel that appointment because he forgot he had X errand to run. I called him back to reschedule and he said he was ill and would call me to reschedule when he felt better. He was also aware that his therapist was unlicensed, but said "Oh I thought they had something worked out under [name of the group]."

Patient #3 had an appt scheduled today. He called and left a brief message saying only that he was cancelling his appt. That's it. No reason and didn't say he wanted to reschedule. So I shot him an email saying I had received his message and asking him if he needed to reschedule or if he intended to discontinue treatment. He said. "I do not wish to see you any further."

I don't know what she's telling them about the whole thing. And I think I'm glad I don't know. Because then I can think she's just being professional and laying out the situation and they're making their own informed choices. Because if that ISN'T the case, I don't want to know about it.

So that's it. I hope I just handled the situation well. I know I did the right thing and I think I handled it professionally, but I still don't like it very much.

Thanks for everyone's advice.
 
Oh those pesky lawyers. And gee whiz, going to school is such a bother, who needs it? :smuggrin: You know if I had known that I could've hung my shingle 11 years ago when I graduated with my BA in history, I could've saved a lot of time and money and apparently been just as good at it. Silly me. :laugh:

:wtf:

Heh. These smilies are fun.
 
sunlioness said:
Oh those pesky lawyers. And gee whiz, going to school is such a bother, who needs it? :smuggrin: You know if I had known that I could've hung my shingle 11 years ago when I graduated with my BA in history, I could've saved a lot of time and money and apparently been just as good at it. Silly me. :laugh:
.
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Take heart in the likelihood that there is an alternative universe out there where you did just that, and someone else's lawyer is complaining about YOU! :laugh:
 
Thanks for making me laugh. :)

So in "More Adventures from Starting a Solo Practice", I received a letter in the mail today informing me that my application to be a Medicare provider has been denied. It has been denied (their bold) because I have not provided sufficient evidence to show that I meet qualifications as a psychiatrist. FACT: (again their punctuation) they asked for additional information that I failed to provide within the allotted time. The real fact is that I did mail them what they wanted, I just neglected to check and make sure they'd gotten it.

But what was it that they needed to prove to them that I have the appropriate credentials to be a psychiatrist? I didn't fill in the line for "Practice Name". I didn't check off a box on the Electronic Funds Transfer form. AND I didn't include a voided check.

People, please make sure your psychiatrist's practice has a name, that they checked the ticky box on the EFT form and that they have a voided check. Make sure of that first thing . . . Because if they don't, they are obviously not qualified. Board certification just isn't enough in these troubled times.
 
sunlioness said:
..
People, please make sure your psychiatrist's practice has a name, that they checked the ticky box on the EFT form and that they have a voided check. Make sure of that first thing . . . Because if they don't, they are obviously not qualified. Board certification just isn't enough in these troubled times.
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No wonder those English teachers couldn't work with you--your credentials were glaringly insufficient!
 
I know! I think I owe them an apology for being such a hypocrite. ;)

Patient #2 left a voicemail and very politely and reasonably discharged himself. FIne with me and I called him back and told him so and wished him well.

Edited: And now patient #1 has discharged himself too. I really do wonder what this woman did. Patient #1 told me he liked me so much because I took his insurance. Otherwise a family member has been paying for his care and the family member apparently liked to stick their nose into it and try to direct his tx given that they were paying for it. "I like that you take my insurance because then it's just me and you." That was why he liked the idea of seeing the LCSW whom he did call --she takes his insurance too. But he called her back to say he couldn't see her for "financial reasons" and now he called me to thank me for being so kind, but to say that he didn't need my services any further. That's fine. I respect his choice. I understand that it's a difficult one, but it still really makes me sad and I worry what she said to these people, worry that she's manipulating them. But I don't KNOW that. So I can't really do anything about it. And I don't really want to know either, actually. I just hope this whole thing is over now.
 
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Therapist4Chnge said:
It is a scary grey area that many untrained and unlicensed people are using to get around all of those pesky laws and regulations meant to protect the general public.
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It's similar to vitamins/supplements vs perscription meds and trainers vs physical therapists-

anyone can promote health/wellness, it takes government approval/licensure to treat illness/disease.
 
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