Facing the Challenge of Liability in Psychotherapy: Practicing Defensively [Hardcover]

Lawrence E. Hedges (Author), Pamela Ann Thatcher (Contributor), A Steven Frankel (Contributor), Ira R. Gorman (Contributor)

Book Description

ISBN-10: 0765703866 | ISBN-13: 978-0765703866 | Publication Date: December 13, 2006 | Edition: 2nd

Facing the Challenge of Liability in Psychotherapy offers ways for therapists of all persuasions to limit liability while continuing to practice effectively. Dr Hedges demonstrates how therapists can put themselves in a position to defend their practices if ever called on to do so; by developing a series of informed consents covering different situations, by learning how to document ordinary as well as critical incidents, by seeking out peer and expert opinion, and by using community resources as appropriate. Most importantly, Dr. Hedges points out the kinds of clinical and dynamic situations that typically lead to complaints and false accusations against therapists. This updated edition addresses three new major areas of concern--work with minors, child custody evaluations, and compliance with the new federal HIPPA regulations. A freshly revised CD-Rom accompanies the book with 30 forms that can be downloaded and adapted.

Editorial Reviews

Review

Malpractice lawsuits and licensing board complaints are a serious threat to the welfare of psychotherapists. It is fantasy to think that only the culpable are brought before licensing boards or become the targets of malpractice litigation. Being a good person and a competent therapist does not guarantee that one will not be forced to defend the profession, often with the very right to continue practicing at stake. Anyone who works with borderline patients, families, children, or very sick patients is at risk. It is that simple, and it is only at one's peril that one denies this fact. In reading Dr. Hedges' latest work, we can take a meaningful step out of the confusion that surrounds many psychotherapists today about the source and nature of their vulnerability before licensure boards and malpractice tribunals. It will be time well spent. (Bryant L. Welch, J.D., Ph.D. )

Dr. Lawrence Hedges' book is an insightful explanation of the ethical and legal pitfalls facing psychotherapists in the new millennium. His in-depth exploration of the issues and his practical suggestions to minimize risks should help therapists avoid ethical dilemmas and possible litigation. Dr. Hedges also explores and refutes a number of popular myths about administrative and civil litigation. This book will be very valuable to any practicing psychotherapist who hopes to avoid being a defendant in a civil suit or in an action by licensing board. (O. Brandt Caudill, Jr., Esq., )

This book is a wonderful gift to the profession, deeply educational and eminently useful. So many of us are babes in the woods concerning the intersection of the clinical, ethical, legal, and human issues in professional practice. Dr. Hedges knows these woods and, through this book, he has made them much safer. He is uniquely qualified for this task. As a depth-oriented therapist, expert on personality disorders, and longtime consultant to therapists, he appreciates the clinical and human issues as well as the risks. As a forensic expert and educator, he has helped many of us to anticipate and handle the hazards, from the most well meaning to the most malevolent. Dr. Hedges loves these woods and I can think of no more knowledgeable and friendly guide with whom to explore them. (Stephen M. Johnson, Ph.D )

...any mental health professional who practices what could be termed ?psychotherapy? will find this an immensely helpful volume, especially if he or she has done no ethics reading since the final implementation of the Health Information Portability and Accountability Act of 1996 (HIPAA) or since recent court decisions have changed the landscape of practicing psychotherapy (p. 209). This is a manual for practicing as defensively as possible, without giving up your principles or delivering an ineffective service to your client. At times one is likely to disagree with the author's recommendations or feel that they are too idealistic. At the same time, it is good for psychotherapists to have an ideal to hold their practices up against. Every time the reader has an objection, I would challenge him or her to make sure there is a good reason for it because Hedges has solid reasoning and years of experience backing every recommendation. The first two chapters lay a solid groundwork for a myriad of basics that alltherapists should consider having as regular practices. Time and again Hedges does an excellent job of reducing a concept to the practical issues involved and gives you a clear idea how to apply it to your practice. ...many of the risks discussed apply (Psyccritiques?Contemporary Psychology: Apa Review Of Books )

Dr. Lawrence Hedges' latest book, the only one of its kind, is an outstandingly comprehensive and comprehensible handbook about the art of practicing defensively. Before I was even half way through the book, I was making changes in the way I conduct my practice. Hedges is eminently qualified to take on this task of educating mental health clinicians to the perils of practicing in these litigious times: he is not only a well-seasoned, highly respected senior psychoanalyst and teacher/supervisor but also the 'go-to' person for therapists in trouble with their licensing boards and/or at risk for being sued. Particularly noteworthy is the passion that fills every single page of this spell-binding volume; clearly, Hedges truly cares and is deeply committed topassing on to the reader all the wisdom he has accumulated from his many years in the field. A real page turner, this essential guide is a must-read for all practitioners interested in learning about what they must do in order to minimize their chances ofhaving either a complaint or a lawsuit filed against them. Ultimately, however, because it gives clinicians the tools necessary to avoid what might otherwise turn into a ghastly nightmare, perhaps the worst experience in their professional lives, Hedges' (Martha Stark, M.D., )

...any mental health professional who practices what could be termed “psychotherapy” will find this an immensely helpful volume, especially if he or she has done no ethics reading since the final implementation of the Health Information Portability and Accountability Act of 1996 (HIPAA) or since recent court decisions have changed the landscape of practicing psychotherapy (p. 209). This is a manual for practicing as defensively as possible, without giving up your principles or delivering an ineffective service to your client. At times one is likely to disagree with the author's recommendations or feel that they are too idealistic. At the same time, it is good for psychotherapists to have an ideal to hold their practices up against. Every time the reader has an objection, I would challenge him or her to make sure there is a good reason for it because Hedges has solid reasoning and years of experience backing every recommendation. The first two chapters lay a solid groundwork for a myriad of basics that all therapists should consider having as regular practices. Time and again Hedges does an excellent job of reducing a concept to the practical issues involved and gives you a clear idea how to apply it to your practice. ...many of the risks discussed apply to the various types of therapy and can be discussed more generally. An excellent chapter points out why we need to rethink the language of dual relationships. This is important not only to psychodynamic practitioners but also to those from other theoretical perspectives. In addition, Hedges covers the required HIPAA discussion, requisite in any book of this kind, in very clear language. Each of these chapters is worth the price of the book alone, as any error you correct could save you up to a hundred or a thousand times the cost of the book retail. The materials on the CD that cover these areas appear helpful and standard, and would not require much—if any—alteration if you are a nonpsychodynamic practitioner. Thus, reading Hedges's offering should h (Psyccritiques—Contemporary Psychology: Apa Review Of Books )

Dr. Lawrence Hedges' latest book, the only one of its kind, is an outstandingly comprehensive and comprehensible handbook about the art of practicing defensively. Before I was even half way through the book, I was making changes in the way I conduct my practice. Hedges is eminently qualified to take on this task of educating mental health clinicians to the perils of practicing in these litigious times: he is not only a well-seasoned, highly respected senior psychoanalyst and teacher/supervisor but also the 'go-to' person for therapists in trouble with their licensing boards and/or at risk for being sued. Particularly noteworthy is the passion that fills every single page of this spell-binding volume; clearly, Hedges truly cares and is deeply committed to passing on to the reader all the wisdom he has accumulated from his many years in the field. A real page turner, this essential guide is a must-read for all practitioners interested in learning about what they must do in order to minimize their chances of having either a complaint or a lawsuit filed against them. Ultimately, however, because it gives clinicians the tools necessary to avoid what might otherwise turn into a ghastly nightmare, perhaps the worst experience in their professional lives, Hedges' book on practicing defensively empowers and holds out hope for all of us. (Martha Stark, M.D., )

About the Author

Lawrence E. Hedges, Ph.D., ABPP, is the leader of a thirty-year clinical research project into the origins of human relationships at the Listening Perspectives Study Center in Orange, California. Dr. Hedges travels widely, lecturing and consulting with psychotherapists on their most difficult—to—treat clients. His work on how early childhood trauma impacts the psychotherapeutic relationship has led him to a keen awareness of how the growing consumer complaint and litigational processes that surround the practice of psychotherapy today are threatening to undermine it and to destroy its effectiveness.

Product Details

• Hardcover: 288 pages
• Publisher: Jason Aronson, Inc.; 2nd edition (December 13, 2006)
• Language: English
• ISBN-10: 0765703866
• ISBN-13: 978-0765703866
• Product Dimensions: 9.2 x 6.3 x 0.8 inches
• Shipping Weight: 1 pounds (View shipping rates and policies)
• Average Customer Review: 1.4 out of 5 stars  See all reviews (5 customer reviews)
• Amazon Best Sellers Rank: #2,095,692 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

8 of 9 people found the following review helpful:

1.0 out of 5 stars Bad and dangerous advice, August 2, 2001

By 

Paul G. Mattiuzzi, Ph.D. (Sacramento, California) - See all my reviews

This review is from: Facing the Challenge of Liability in Psychotherapy: Practicing Defensively (Hardcover)

I recently spoke with a colleague who was seeking advice about responding to a request for information from an attorney about a former patient. The psychologist was somewhat distressed by the inquiry. I saw it as a routine matter. She mentioned that she had read a book, which is the subject of this review, and that it had given her great reason to worry about liability.

I knew the authors name and decided I should read his book.

The author makes some interesting points and provides some useful information. I would suggest, however, that on the whole, this text it is not to be trusted.

Described on the dust jacket as a comprehensive handbook for all therapists, Practicing Defensively is more uniquely focused on the challenges faced by clinicians who do long-term depth and dynamic work with seriously disturbed patients. It primarily addresses the threat of false accusations and licensing board actions. Included are a number of forms which can be copied from an accompanying CD. Many are standard, some are unique (e.g., consent to feed my children during therapy).

The text first gives reason for pause in a discussion about how to respond to a subpoena. A forceful, cautious and defiant response is advocated, but no consideration is given to the context or circumstances surrounding the request. It is suggested that the Supreme Courts 1996 Jaffee decision be cited (Jaffee was the first Supreme Court ruling to recognize a psychotherapist privilege), but the case is miscited, the facts are misstated, and the ruling is misinterpreted. The author goes on to note that if records must be produced, they should be taken directly to the judge, and sealed with a warning reading in part: anyone daring to break this seal violates 2000 years of Roman and Anglo Saxon Law which guarantees sanctuary and privacy to all citizens. My guess is that this warning might be dismissed as an eccentricity. But I think it is more likely to be viewed as odd, immature, or unprofessional.

Additional examples of questionable advice are included. For example, the precise elements of privilege and confidentiality for minors seem to be misunderstood. A standard form for authorizing the release of information does not appear to be well drafted: it unnecessarily authorizes two-way communications, omits the signature of a witness, includes any information desired, and sets the expiration date at five years. At a clinical level, it is suggested that the only way in which symptoms from early trauma can be resolved is by causing them to be relived or reexperienced in therapy.

What is of most concern about this book is the attitude adopted towards licensing boards. It appears that no legitimate purpose for a boards existence is recognized. Instead, the author endorses the proposition that we need to remain in a constant watchdog and adversarial position. He says that we must stand against unfair enforcement and unwarranted intrusion by the state into our professional affairs, and that the rule is not to believe anything state boards put out because it is all so highly subject to political and financial motivation. It is said that those who sit on licensing boards and ethics committees have been seduced ... into naive and nonsensical moralizing and that their efforts can only lead to endless travesties of justice. They are accused of careless prosecutions which are heavily biased in favor of conviction.

A centerpiece for this book is the authors discussion of his reaction to a complaint against a colleague and the subsequent investigation. He sets the tone for the experience by recounting a dream about Nazi atrocities, the smell of burning flesh, and jack booted thugs knocking on doors. He describes an administrative monster (that) continues to grind out injustices that destroy (the) lives of my professional colleagues, the farce of administrative justice, and the needless damage (caused by) board stupidity. Before it was even investigated, the author knew that the complaint was unjustified. After all, the clinician had discussed the case for years in conferences with many colleagues. She was known as Howards case from Hell, and was described by the author as a woman who undoubtedly would have been burned at the stake as a witch. In preparing to fight for his colleague, the author railed against the f---ing boards, noting that those state guys all have a police mentality - blind, ignorant, vindictive. They are dangerous. The anti-climax to the story is that the complaint was dismissed as soon as it was investigated.

I read this book because I believed it caused a colleague to worry needlessly, and invited her to respond incorrectly to a potentially delicate situation. I would suggest more generally that it would be a risk to rely upon this tract for anything more than its basic warning: be careful, practice defensively. Common sense would provide a better guide than much of the advice offered. Rather than protecting a clinician, I would suggest that adopting the authors attitude and perspective is more likely to lead to errors, mistakes and misjudgments, for which the liability might be real.

3 of 4 people found the following review helpful:

3.0 out of 5 stars Facing the need to be defensive, January 25, 2002

By 

postdocfromsf "barbara_from_berkeley" (Berkeley, CA USA) - See all my reviews

This review is from: Facing the Challenge of Liability in Psychotherapy: Practicing Defensively (Hardcover)

I found the Paul G. Mattiuzzi, Ph.D. review helpful, but a little extreme in the manner similar to his complaints about L. E. Hedges. These are confusing times for the practice of psychotherapy and a discussion of the problems that one can face, including models for addressing some of those problems, contributes to the effort to produce a more tempered solution for our changing profession. Therapeutic manuals and manual- oriented software like Therascribe are other examples of similar guide-driven change, but these tools require a tempered approach too. In other words, if you can see the opposing poles, it is a little easier to find a middle ground.

I would hope that the professionals that look at this book would realize that it does not obsolete professional consultation. As Dr. Mattiuzzi's colleague sought him out, I have often used these sample documents as an example to stimulate discussions with colleagues. In all cases, we usually come up with a modified solution suited to the given situation, but the sample document gave us a good starting place. Blindly applying these documents would be as disastrous as not addressing our new practice demands at all. Solo practice needs to be safer and more efficient for the consumer and the practitioner. If people find any of the sample pages on Amazon interesting, consider sharing the expense of this book among a group of colleagues.

4 of 6 people found the following review helpful:

1.0 out of 5 stars Rampant paranoia pitting therapists against their clients, April 26, 2002

By A Customer

This review is from: Facing the Challenge of Liability in Psychotherapy: Practicing Defensively (Hardcover)

This writer has created a tome which has the potential to scare the living daylights of any therapist trying to work with clients . His focus on practicing defensively seems to overlook the obvious fact that such a posture taken with clients from the outset is oxymoronic. Clients come to therapists with the need and expectation of a therapeutic alliance. No one call ally themselves with an individual whose initial and ongoing posture is one of self-protection, defensiveness, and guardedness.

Hedges' comments regarding transference issues as the basis for complaints and his over-emphasis on these as the source of dissatisfaction in clients leads any knowledgeable reader to wonder to what extent his own strong countertransference issues related to clients of ANY kind are at work in his writing OR in his actual practice. His hostility toward clients and toward administrative/licensing boards is overt and interferes with his ability to provide balanced clarity in dealing with the issues he discusses.

In my opinion, any therapist who adopts his vantage point for approaching clients will soon have no clients. Clients have an intuitive sense regarding their therapists' perceptions of them. Being handed stacks of legal papers to sign and a myriad of other documents designed to protect the therapist (of course, under the guise of protecting both) at the outset of therapy precludes the possibility that any meaningful work will get done or any therapeutic alliance could be formed. Clients are not a stupid as he appears to suppose.

While the issue of practicing with common sense about legal and administrative issues is important, Hedges' approach focuses only on negative, confrontive, and overtly hostile interactions with clients--to the detriment of all concerned. Any therapist who seeks to help clients knows that taking such a legalistic approach and allowing it to pervade every interaction with clients would be counterproductive.

As one reads this book, one is struck by the intense frustration and anger which pervades its pages. It leads one to ask the questions--what infantile traumas have yet to be dealt with in therapy by this author? or, as the famous commercial used to say, "what's his beef?"

Let us hope another author can approach this subject without Hedges' open hostility and paranoia toward clients so that balanced methods can be developed to address relevant issues without defeating the entire purpose of the therapeutic process. Only a therapist who has completely given up on the healing aspects of therapy would take this book seriously. And for those who have given up, why not turn to a line of work that doesn't require such vigilance and paranoia on a daily basis?