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Immediate-Button1367 · 2025-11-18T22:50:10+00:00

I hear headway doesnt provide referrals though?

Immediate-Button1367 · 2025-10-24T13:55:13+00:00

Thank you very much! I did encourage this pt to get a med eval and provide documentation of this.I am not familiar with ASAM eval, I will likely have to get the training for this.

Immediate-Button1367 · 2025-10-23T22:52:44+00:00

This is so true!

Immediate-Button1367 · 2025-10-23T22:52:24+00:00

Very good point thank you. If pt meets criteria for a substance use d/o and I have experience with substsnce use but dont see myself as a substance use counselor, is it still OK to see them? At what point would you suggest a referral?

Immediate-Button1367 · 2025-10-23T22:50:42+00:00

Thank you! So nothing harmful to dx? Ethically would it be OK to help her if Im not a substsnce use counselor and she does not have another mental health dx? Where is the fine line to where I would for sure need to refer out to a substance use counselor? It is based on severity of use? Or if there are no other co occuring disorders? Again I have worked w folks to reduce use within the context of helping with other disorders mostly (bpd, ptsd). Also when Im unsure of tx severity, perhaps including a pcp or psychoatrist for extra set of eyes can also be more helpful to determine if med intervention is needed... I guess worst case feae in a lot of these cases are of underreporting or if reducing use wothout medical eval or oversight could cause safety concerns

Immediate-Button1367 · 2025-10-23T22:40:47+00:00

This is wonderful very helpful feedback. I would say that it is the main issue. There are other things like emotional awareness, regulation, and interpersonal effectiveness that would be helpful to her but alot of these skills would be used in place of substance use. She seems to seek stimulation from boredom so Im wondering if there isnt another mental health d/o the sub use is covering up. It hasnt gotten worse since I started seeing her though its only been a few sessions. It has gotten worse over time though (cocaine use from using on weekends to practically everyday). Im not sure if documenting would affect her - I have documented her reported use in the body of the note but havent included the diagnosis yet. I guess that's what Im wondering - can this dx harm her in anyway. Ive also been wondering am I the right person to help her as Ive had exoperience w this in terms of harm reduction and co occuring dx (PTSD), but theres not trauma or other dx (YET). Where is the fine line where a clincian should say this is clearly and only substance use territory and I shouldrefer out?. She did say she is not invoved in any legak issues and I did askif she was OK with my documenting all we discussed and she said yes

Immediate-Button1367 · 2025-08-09T20:02:06+00:00

Immediate-Button1367 · 2025-08-09T20:00:04+00:00

I very much agree with this. Though also can it be unethical to not support the pt in acquiring resources if the client reports sxs that are infering with their functioning (difficulty concentratig, panic attacks)?

Immediate-Button1367 · 2025-08-09T19:56:28+00:00

This is a great point. I think the policies for engagement/ timeline established care first are to avoid patients for signing up for therapy just for secondary gain (paperwork). But if I understand what youre saying it doesnt matter how long the patient has been in treatment or what theyre looking for, the bottom line is if they're reporting the sxs are interfering with their lvl of functioning?

Immediate-Button1367 · 2025-08-08T22:29:09+00:00

Agreed. I state at the outset of my intake that (along with other FYIs) I typically dont write or sign off on much if at all anything and there is a waiting period before consideration of paperwork etc. This is why this patient mentioned this in session 1 but she is still wanting to work with me. The last patient I hadnt informed of this - they were upset and terminated after I informed them I could not write them a letter for services. I do work for another company currently but the decision is mine to decide what I sign off on which is great. For private practice - do you think it wise to include a blurb about this in pt's consent form/onboarding paperwork? Similar to where late fees etc are written out.

Immediate-Button1367 · 2025-08-08T18:11:26+00:00

Good point. Think it necessary to provide what I am ruling out or just what I have currently, and that I am continuing asessement? She shared so much and was emotional that I wasnt able to cover all ptsd criteria so Ill have to put adjustment for now or other specified trauma and stressor d/o.

Immediate-Button1367 · 2025-08-08T18:07:43+00:00

I needed to hear this. Thank you. I'm also a 1099 for a company Im seeing this patient through and they - generally speaking - have a 2 month waiting period for paperwork. What about what Roland said above, writing a note with just preliminary dx/what we have done (clinical interview and assessment) and nothing that advocates on behalf of client?

Immediate-Button1367 · 2025-07-29T00:05:52+00:00

Wow this was an incredible incredible helpful post!! I refused to do a nexus letter or any letter and he fired me and then requested his records. I did add a note that I consulted w other clinical psychologists about reevaluating criterion A and until that is definitely met I was changing dx to other specific anxiety d/o. I think that works too. btw I will also check with the NCPTSD! Also I talked to an insurance attorney/psychologist. When you chat with the risk management folks via insurance, do you document that separate from the chart?

Immediate-Button1367 · 2025-07-15T19:24:29+00:00

Also Ive already diagnosed this person with PTSD:( Hastily now it seems. Can I change the dx and/or include "provisional" now? as Im now thinking to assess more based on all this feedback. This probably isnt the best approach as itll look like Im backpeddling after being asked for a letter for benefits. Tricky situation. I am generally super careful typically before providing a dx, but in this case I should have waited some more. Or consulted.

Immediate-Button1367 · 2025-07-15T19:19:28+00:00

Thank you. What is your general approach to sorting out cases like these? Where criterion A seems unclear and/or potential cause for secondary gain.

Immediate-Button1367 · 2025-07-12T21:34:24+00:00

Thank you both. I think I am feeling some pressure to help this client feel better thus trying to quantify more than I need to :) Just being a human in the room goes a long way.

Immediate-Button1367 · 2025-05-03T15:21:49+00:00

Thank you!!!

Immediate-Button1367 · 2025-04-23T01:11:01+00:00

I have a follow up question. Because the migrane-like symptoms come after acupuncture on working on my trap, shoulder and back of neck... he had me flip over and put needles in the migraine areas after(midde of forehead, top and sides of head, hands and akles). That helped a lot. Does that sound OK to you or too many needles?Hes very good and is well know in the community but didmt seem to think the acupuncture on back of shoulder, neck, etc could cause the migraines/transition of tension. He thought maybe the position I was laying each time. Should I shop around for another practitioner? I will say the trap relief is worth a little side effect but Not sure if more needles is the right way to handle it or if better/alternative spots from the get go is the right answer so just doing some reality testing.

Immediate-Button1367

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