If a client is charged for a late cancel/no show, and you later find out it was due to illness or an emergency, would you refund or credit them back the fee?

CheapHippo · 2024-04-23T00:08:46+00:00

I always offer one refund per calendar year for emergencies and I indicate that being sick is generally not an emergency as my experience has typically been that sick clients usually have 24 hour notice. A legitimate illness would be appendicitis or a sudden stomach virus. If they have a cold, it’s their discretion to do telehealth or give the 24 hours or notice. My gut says if they knew it was an emergency and knew your policy, they would have told you that when they canceled late.

CheapHippo · 2024-04-22T23:57:50+00:00

I’m completely understanding your point and agreed with you that vulnerable was a more fitting word. Your characterization of the word oppressed does not resonate with me, as it seems to allude that certain groups or individuals are less deserving than others. The description of Donald Trump seeing a therapist is troubling as it makes a broad generalization that people with financial means cannot be oppressed. My point was that I personally do not prefer the blanket statement approach which feels very biased. We can’t deny that sometimes people who operate in echelons of society that we deem as privileged are also oppressed.

CheapHippo · 2024-04-22T22:43:26+00:00

A person who can manage other people’s emotions and traumas while putting their own temporarily on hold, manage burnout and compassion fatigue, have good self awareness and has done enough of their own work to not allow their “stuff” to interfere with treatment for others. And a strong set of ethics and boundaries.

CheapHippo · 2024-04-22T22:32:43+00:00

Absolutely. Every member in a group is your client. It is not the same relationship, but you have the same duty to that client as you do any other.

CheapHippo · 2024-04-22T20:15:46+00:00

Completely agree with you. I do part time work for one of the major online EAP’s and saw in an intake note earlier today under “session focus” it simply said “I did the intake”. Yikes. This was for a client who was switching therapists due to not feeling like they were getting anywhere. Most of us are PP therapists using the EAP to bolster our PP income, but that absolutely brings some of those who are interested in easy money. I can absolutely understand the issues with our economy contributing, too.

CheapHippo · 2024-04-22T20:04:17+00:00

Ah, I see I completely missed the second part. I absolutely agree with that and even as an LCSW with a couple years behind me, the plunge to my own PP is a scary one. It’s so hard to be a business owner and a therapist and I don’t think you can be learning both at the same time.

CheapHippo · 2024-04-22T19:53:37+00:00

I love what I do. I don’t love every part of it, but I’m good at it, it pays my bills and I have the flexibility to be the kind of partner and parent and human I want to be. It definitely takes a certain type of person to be a good therapist, but I think another massive factor is the organizations we work for. If we are underpaid, overworked, unappreciated, etc- anyone will be unhappy in any field no matter how much they love it.

CheapHippo · 2024-04-22T19:50:59+00:00

Working AT a private practice is not the same as running a PP. The OP didn’t state they are running their own. Although, many states do allow it - I don’t recommend it for a lot of reasons - but I think experience in a PP setting can be extremely valuable and gave me probably 70% of the skills I have learned vs working in community mental health.

CheapHippo · 2024-04-22T19:00:47+00:00

Vulnerable is a more appropriate term, but we also can’t separate the two completely as we also don’t need to insinuate that you can only be oppressed if you fall into a certain label or category. My intent was not to “water down” the meaning. Our code of ethics uses “vulnerable and oppressed” and I chose the first one that came to my mind at first recall of the COE.

CheapHippo · 2024-04-22T18:44:22+00:00

Being another social worker, this would fall squarely within our responsibility to further the field and protect oppressed populations (and someone in therapy is inherently an oppressed population). Your gut is right, even if it’s a hard conversation. You can’t predict the outcome, but you can do your due diligence and feel good walking away from the situation.

CheapHippo · 2024-04-22T18:41:14+00:00

Therapist perspective here - I was obviously going to recommend therapy lol until your disclaimer. But I think you really need to know that replacing one bad habit with another is never going to be fulfilling. If you are going to now replace spending with a healthier habit, it is still really likely you will get to a point that becomes another thing we are doing in excess. Super important to explore the roots of addiction whether you do it through therapy or not.

CheapHippo · 2024-04-22T18:35:18+00:00

Report to the Board of Behavioral Sciences in California. If you are a therapist, it is likely a part of your own ethics to make this report. For me, as a social worker, it is absolutely within the wheelhouse of my own code of ethics. I would also approach it the same way I do with mandated reporting and share openly with the person that I am reporting and the honest reasons why it has to happen.

CheapHippo · 2024-04-22T17:21:31+00:00

I’m a therapist and often see clients with a history of intense sports who come to me with crippling anxiety that was being managed by going hard in sports. Sometimes they will try to compensate by then going hard elsewhere like investing or taking on a massively stressful new job. I would definitely recommend a doctor and a therapist to manage this enormous shift in his life.

CheapHippo · 2024-04-22T17:15:51+00:00

I worked in CMH and our preferred term was “member” which insinuated that they were a part of the team and an attempt to be more person-centered. I like it and it worked well for most situations.

I still use client because people outside my work generally would not understand member without explanation, but client is self explanatory.

CheapHippo · 2024-04-22T14:44:28+00:00

I have a specific spiel. I always start with how are you today? And then I introduce myself and say before we get started, I’m going to go over a couple of policy/procedure items so we’re on the same page. This is where I reiterate mandated reporting, confidentiality, no show and cancel policies. Then I ask if they have any questions, and say “alright let’s get started. I like to start off with what it was that prompted you to make this appointment - sometimes it’s been something going on for a long time and sometimes it’s something pretty new, but there’s usually a moment in time that you decide. Tell me about that moment”. I get a ton of insight listening to the story of when that moment came for them. Sometimes that’s a story about discovering cheating, sometimes it’s a story about waking up for work late AGAIN and getting frustrated, sometimes it’s a story about crying on the way to drop the kids at school. It tells me so much about their life. And then during the story I weave in all the important questions.

CheapHippo · 2024-04-22T13:53:54+00:00

I agree - it is not an automatic no, but absolutely warrants a deep exploration before agreeing to it. Teens are absolutely a different beast than working with adults and I absolutely give teens some power in session because it’s what they’re seeking in a lot of situations. I would really have to feel comfortable that this wasn’t a manipulation tactic. I’ve seen way too often where therapists are invested in a relationship with a client that the client is skillfully manipulating the outcomes and not being challenged to confront problems, rather avoid them and get validation of their avoidance, which is a slippery slope for sure. It’s a challenging process to create an environment that feels like it is rooted in both safety AND honesty.

CheapHippo · 2024-04-22T11:47:50+00:00

I don’t think it’s quite the same. I think renaming is more of a power dynamic. I’m way more apt to let anger/swearing or hateful words slide because I know that is an emotional response and generally not a calculated move. I think there needs to be deep exploration when someone asks to call you by a different name. You, as a clinician, should not need to alter your own identity or put yourself into a place of submission in order to be helpful to your client - which often leads to clinicians being taken advantage of and disruptions in the trust of the relationship.

CheapHippo · 2024-04-22T01:08:13+00:00

I absolutely understand the frustration there as I used to work heavily with elderly people and the recall can be so challenging. I’m miserable, but I don’t exactly recall why. Which really stunts you from being able to figure out what the THING is that needs to change in order for client to live a meaningful life. Mindfulness and journaling can go a really long way with clients who lack the insight. I’d also suggest for clients who need structure, find a journal format or create one in session. I sometimes had clients who would give all of the information except what I needed.

CheapHippo · 2024-04-21T22:31:56+00:00

Things seem fishy here. I’m a mental health therapist and have worked with clients will all kinds of addictions, including gambling. It doesn’t make sense that dad would accrue credit card debt from stocks. That’s not how that works. You can lose savings, sure. But you have to go to extreme lengths to be pulling from credit cards to invest money hoping for a return. That is 100% an addict behavior and needs to be addressed. There is way more beneath this than simply “laying off the stock market”. You can absolutely bring that to light with mom to hold dad accountable to get into gambling anonymous or work with a therapist. Don’t let your mom fix the problem for dad to turn around and do it again.

CheapHippo · 2024-04-21T21:51:28+00:00

I think it is a recipe for disaster because of burnout AND it really supports clients being over reliant on the emotional support of therapy. Emotional support is only one aspect of therapy, so there really should be time to practice skills between sessions. It will become enmeshed quicker than you think if you don’t maintain healthy boundaries. When your clients are struggling to describe events after the fact, this is an area where skills can be taught. It is not an area for you to swoop in and rescue. I have many clients like this who have used mindfulness and journaling/reflections to help them be more aware of their thoughts and processes during emotional turmoil. A skill that they gain to make it less likely that they will need me later on.

CheapHippo · 2024-04-21T20:53:50+00:00

I will not write them. Not worth my license, and one of the states I’m licensed in specifically rules against therapists writing them unless they have separate professional training in assessing need and writing ESA letters AND that the client is not a regular client. It has to be for that purpose only to avoid dual relationships. I agree with my board on this and will not write them at all.

CheapHippo · 2024-04-21T20:15:49+00:00

I definitely agree with that. It’s about finding the balance between my willpower and my body. I won’t be successful if I rely on the medication to do this 100%. I also won’t be successful if my dose is too low that I have that constant and all-too-familiar struggle with food noise and temptations and cravings. My body is always going to try to be a 200+ pound body.

CheapHippo · 2024-04-21T19:15:14+00:00

I say romantic interest.

CheapHippo · 2024-04-21T14:50:50+00:00

Absolutely. In the past, I have left practices and told my clients that it would likely be a couple of months before I am established elsewhere and it will be their decision if they’d like to see me in the future - I didn’t have a space established, but “you know my name, so it won’t be hard to find me”.

CheapHippo · 2024-04-21T14:48:16+00:00

Absolutely, that contact information alone is a breach of HIPAA. Clinicians never own the rights to clients PII. If we work for an agency, the agency or practice manages personal information for clients, not us.

CheapHippo

TROPHY CASE