Creating Your Professional Will

Last year, I decided to update my professional and choose new members for my Emergency Response Team, these are the people who would manage my business affairs if I became seriously ill or in the event of my death. When the coronavirus hit, I wanted my will to be current in case I got sick and could no longer care for my clients. Both people I contacted readily agreed and said they felt honored to be asked.

Creating a professional will is not difficult, the challenging part for me was calling my friends and requesting their help because I know it’s a big responsibility. Before you create your will, think about who you’d like to coordinate care for your clients in your absence. The colleagues I chose both specialize in addiction and trauma as I do.

I suggest you find at least two people. One of their main responsibilities would be calling your clients to inform them of the situation and providing them with referrals if needed. In the event of your death, your team would access to your office and any paper records. I maintain electronic records and my brother is my delegate for my password management software; he’ll be in charge of providing my friends with access to my records and managing any outstanding financial issues. If you use paper files, I recommend creating a list of your active clients and filing it with your professional will.

As therapists we have an ethical responsibility to our clients and our colleagues to keep our business affairs organized. I know it’s not pleasant to think about the possibility of getting seriously ill or our inevitable death, it’s comforting for me to know my affairs are in order during these uncertain times.

You can find professional will templates online and I’ve included the link to CAMFT’s template below https://www.camft.org/LinkClick.aspx?fileticket=8V-aZFCfl7s%3d&portalid=0

Choosing the Right Telemedicine Software

Choosing the Right Telemedicine Software
Due to the Coronavirus (COVID-19), many of us have moved our practices online to protect our health and the health of our clients. I have always offered online sessions to clients who travel or simply prefer not to drive in LA traffic. When I started doing video sessions I inquired with CAMFT about HIPAA privacy rules and video conferencing software for telemedicine. The first step in choosing the right software is determining whether you are a HIPAA-covered entity.

Here are three questions you need to ask yourself; you must answer yes to all three to qualify.

1. Are you a healthcare provider? The answer is yes for psychotherapists.

2. Do you transmit health information electronically?

3. Do you conduct covered transactions? According to CAMFT- “A covered transaction for HIPAA's purposes involves transmitting information between covered entities to carry out certain financial or administrative activities related to health care.” From David Jensen JD’s 2010 Article- “Are You A Covered Entity”CAMFT’s website and verified by phone

Since I am not on any insurance panels and do not transmit health information electronically, I answered no to questions 2 and 3.  I chose to use ZOOM, which is not HIPAA compliant.

When researching software choices, be sure to ask about the software’s privacy protocols.  Ask if the sessions are recorded and who has access to that server. If you are a HIPAA covered entity, check out VSee, one of the more popular HIPAA compliant platforms.

California law says we must maintain confidentiality and reasonable security when we conduct telemedicine sessions.  If you need more information about telemedicine, you can find it on CAMFT’s website www.camft.org.

The Language of Suicide

photo by Rod Long on Unsplash

One of my specialties is grief and loss, and early in my career I did an intensive training at a remarkable place called “Our House” in Los Angeles. During the training, we were encouraged to share our personal experience with grief and discuss our family traditions when someone died. The leaders emphasized the importance of using the correct language when talking to our clients about death.

We were taught to use the word “die” instead of “passed” and avoid saying someone “committed suicide”, because that phrase implies someone “committed” a crime. Instead they recommended saying someone “suicided”, died by suicide, or ended their life.

Last year I lost a close friend to suicide, she was the second friend who took her life in 2019. When someone dies by suicide, people are often unsure about how to respond.  Sometimes they’ll ask questions about the details of the death which is re-traumatizing for the grieving person. In our death denying culture, we need to find a way to get comfortable talking about suicide and listening to those who have suffered the loss of a loved one.

Didi Hirsch Mental Health Services https://didihirsch.org/services/suicide-prevention/ opened the first suicide prevention center in Los Angeles in 1958. Today their state-of-the-art facility offers a variety of support groups for the general public and specialized training for professionals.

California recently passed a new law requiring mental health providers to complete six hours of continuing education in suicide prevention. Those already licensed will be required to complete this one time training at the time of their first renewal that takes place on or after January 1, 2021, to learn more about the requirements of this law go to https://www.bbs.ca.gov/pdf/suicide_prevention.pdf 

Gratitude Season

It’s November and soon we’ll be celebrating Thanksgiving. It’s my favorite holiday, I love cooking and spending time with my family. My nieces are anticipating my questions about what they are grateful for.

I express my gratitude whenever I receive a referral from a colleague. I consider it an honor and a privilege for someone to have faith in my abilities as a therapist. (I’m not talking about the times where a therapist you don’t know sends you a difficult client without calling you first!). When I receive a referral, I send the person a handwritten thank you note in the mail. Several people have said that they felt pleasantly surprised when they received my note.

Dr. Martin Seligman is the founder of Positive Psychology. Seligman’s research supports the idea that practicing gratitude can increase your level of happiness. Dr. Seligman and his colleagues developed a practice called the Gratitude Visit. This is something you can share with your clients.

1. Close your eyes.

2. Take a moment and try and remember the face of someone who did or said something that had a major positive impact on your life.

3. Take some time to reflect on how that person impacted your life and notice what happens inside.

4. Write a letter to that person. Include specific examples explaining what the person did for you and why you are grateful for that person.

5. Deliver it in person

This can also be done using a person who is no longer living by modifying Step 5 in whatever way feels meaningful.

The research revealed that those who wrote the letters became much happier during and after the study. If you’d like to learn more about Dr. Seligman’s research go to https://ppc.sas.upenn.edu/research/positive-psychology-research

Please Hang Up and Call 911

Most of the therapists I know use some version of this language on their voicemail “If this is a client experiencing a medical emergency, please hang up and dial 911 or go to your nearest emergency room.”   I wondered if I really needed this. Of course, I understood we use it for legal reasons, but I thought it sounded strange. I like to understand why I’m doing something in my business as opposed to just adopting a practice that everyone uses.

I decided to call CAMFT and ask them about the greeting. Access to the lawyers at CAMFT is one of the many benefits of my membership. I spoke with Bradley Jordan Muldrow, JD, and I asked him why I needed to use this greeting on my voicemail. Bradley advised me to retain the greeting, he explained that it serves as an important reminder to my clients that I’m not available 24/7. He explained that if a client was calling at 2:00AM, I would not be expected to answer the phone and my message would inform them of their options in a true emergency. He said that the combination of the greeting and language in my informed consent document help to protect me from potential liability, so I chose to retain the language in my greeting.

I took the opportunity to ask another question. When I was an intern (before they were called associates), my supervisor would cover my practice when I was on vacation and vice versa. My voicemail message would state that clients should contact my supervisor in the event of an emergency. I wanted to know if I needed to have another clinician cover for me when I took time off. Bradley explained that I was not responsible for covering my practice during my vacations; all I need to do is create a vacation greeting that includes the same emergency language as my regular greeting.

It’s important that we maintain clear boundaries with our clients and that we can be flexible when it’s clinically appropriate. I encourage my clients to contact me if they are experiencing a non-life-threatening crisis, but I limit these calls to approximately ten minutes. If someone needs more time, I’ll suggest we schedule a session. I’ve only had a few clients who called frequently between sessions and when that happened, I offered them a second weekly session. Of course, your policies may be different based on the types of clients you see and your personal preferences. Now might be a good time to review your voicemail greeting and see if it’s up to date.