January 1st, 2015

“The Ethics of Private Practice: A Practical Guide for Mental Health Clinicians”

“The Ethics of Private Practice: A Practical Guide for Mental Health Clinicians”

By Jeffrey E. Barnett, Jeffrey Zimmerman & Steven Walfish

Oxford University Press

New York, N.Y., 2014

 

Authors emphasize practical business matters in ethics book

Reviewed by Paul Efthim, Ph.D.

What would you rather do: (a) read a book about ethics or (b) take castor oil?

Either way, we fear it’ll taste like bitter medicine administered by punitive authorities for the purpose of ensuring internal cleanliness.

It doesn’t have to be this way. Connecticut psychologist Jeffrey Zimmerman, Ph.D., ABPP, together with colleagues Jeffrey Barnett, Psy.D., ABPP and Steven Walfish, Ph.D., recently published “The Ethics of Private Practice,” a decidedly non-castor-oily guidebook. Conversational in tone, well-written, easily digested front-to-back or usable as a reference when questions arise, this 192-page paperback takes a pragmatic approach to the ethical challenges faced in clinical work.

Why another ethics book, when there are several excellent ones already on the market?  (Gerry Koocher and Patricia Keith-Spiegel’s classic text comes to mind. Also Ken Pope and Melba Vasquez’s volume, and Pope’s great Web site.) The unique value of “The Ethics of Private Practice” is its focus on how the day-to-day business of running a solo or group practice is awash in ethical considerations.

All three co-authors have extensive experience in independent practice and have published widely on clinical practice, ethics and the business of practice. Speaking collectively in the tone of a kindly mentor, they offer extensive advice to novice and experienced clinicians alike. The book is structured to follow the sequence of a practitioner’s career: the first chapter addresses ethical issues in starting a practice, the last chapter considers how to close a practice and everything else gets sandwiched in between.

Zimmerman and his colleagues emphasize the practical business matters of conducting one’s practice. There are chapters on documentation, dealing with insurance and other third parties, financial decisions, staff training, advertising and marketing and continuing education. They devote relatively light treatment to ethical aspects of administering psychological interventions (e.g., clinical competence, informed consent, boundaries), deferring to other books that go into depth on these issues.

Some of the strongest and probably most important guidance comes around billing and finances. Rare is the clinician who has had adequate preparation in dealing with money matters prior to hanging out a shingle. The authors note that insurance and fee problems are second only to sexual misconduct as a source of complaints against psychologists handled by the APA Ethics Committee.

Fee setting, sliding fee scales, collections, and dealing with managed care companies are all examined through an ethical lens. We get clarity about what constitutes insurance fraud and how to avoid it.

The authors offer concrete advice throughout. For example, they advocate keeping treatment records indefinitely, both for possible use in defending oneself against charges leveled many years later and also to support patients’ possible need for documentation long after treatment has ended. An extensive chapter on training administrative staff and setting office policies is a must-read for those running group practices.

This well-organized book features handy summaries at the end of each chapter highlighting key points with references to the relevant sections of the APA and other relevant ethical codes. The authors provide several sample documents that can be modified to use in one’s practice (such as a letter to a patient who has dropped out).

The attentive reader comes away with an appreciation of ethics not so much as a set of castor-oily rules but rather a set of principles and processes that work hand-in-hand with sound business practices to produce top-notch clinical care.

Paul Efthim, Ph.D. is a licensed psychologist in private practice in Brookline, Mass. He holds a faculty appointment at the Boston Institute for Psychotherapy and is a candidate at the Massachusetts Institute for Psychoanalysis.

By Paul Efthim PhD

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