When prospective clients call on the phone to ask about your services, some will also tell you a little about their problem. At this point, you may want to listen empathetically. But do not ask probing questions.
After speaking with you for a few minutes, a prospective client may make an appointment and then ask for suggestions on how to cope with their situation until they get in to see you. Resist the urge to give advice.
Why should you not be helpful? Isn’t that just good customer service? Being helpful is good customer service. However, in our business we need to be careful – for risk management reasons – not to engage in diagnostic or therapeutic services until we have the person’s informed consent.
Simply asking questions or giving general advice might erroneously communicate to someone that you have established a professional relationship with them. Most of the time that will be inconsequential; however, in rare cases, it could backfire. Here’s a hypothetical example:
Mrs. V, who is seeking help for her rebellious teenage daughter, calls you in desperation. “You’ve come highly recommended,” she says anxiously, “and I’d like to get her in as soon as possible.”
After checking your calendar, you offer her an appointment for early next week. “Thank you!” she exclaims. “I’ll be there. But can I ask one quick question first? My daughter is grounded for two weeks, but she has a gymnastics competition this weekend. Should we make an exception for that?”
Since you’re not busy, you figure it won’t hurt to spend a few minutes helping Mrs. V with this decision. It’s also an opportunity to establish rapport and to impress her with your expertise. So you ask a couple of questions about her daughter and about the family. Her story sounds like many you’ve heard, and you advise her to keep her daughter home from the gymnastics tournament.
The following Monday, Mrs. V calls to cancel her appointment because her daughter is in the hospital after cutting herself. She also threatens to sue you for malpractice and to report you to your licensing board.
Mrs. V may or may not prevail in a lawsuit or licensing board complaint. However, it is apparent that she did assume, from the way you communicated, that she was already in a professional relationship with you. Even though she had not yet met you in person, you were behaving like a treating psychologist, simply by asking probing diagnostic questions and giving specific advice.
The APA ethics code is silent on exactly when a therapeutic relationship begins. According to experienced ethics instructor Dan Taube JD, PhD, who serves as risk management consultant for The Trust, a professional relationship can be assumed simply from the behavior and intent of both parties. Moreover, intent need not be stated; it can be inferred in the absence of informed consent – as was the case in the hypothetical example of Mrs. V.
There are also good business reasons for not being too helpful at the inquiry stage. Ethical and risk-management considerations aside, giving advice to prospective clients may make them less likely to schedule an appointment right away, especially if they are ambivalent about starting therapy.
People are more motivated to take immediate action when pain or discomfort is involved. Therefore, if your symptom-focused advice to an ambivalent prospective client takes the edge off their distress, it’s quite possible that instead of making an appointment immediately, they promise to call back later. By the time “later” comes around, they may have forgotten your name.
What about giving advice in public education writing and speaking?
Taube recommends against giving specific advice, not only when talking to prospective clients, but also in nonclinical situations, such as presentations to community groups, interviews with news media and written articles for the public.
This does not imply that we should avoid speaking to or writing for public audiences. To the contrary, we have a professional obligation to provide the public with science-based information of general interest.
Section 5.04 of the APA ethics code outlines criteria for providing information to the public, but it does not prohibit nor discourage giving general tips or advice. When psychologists provide public advice or comment via print, internet, or other electronic transmission, they take precautions to ensure that statements:
- Are based on their professional knowledge, training, or experience in accord with appropriate psychological literature and practice
- Are otherwise consistent with this Ethics Code; and
- Do not indicate that a professional relationship has been established with the recipient.
APA’s “Psychology Help Center” (apa.org/helpcenter) has some good examples of how to give general practical tips that are not likely to be interpreted as treatment. In addition, many psychologists add a disclaimer to their public education articles that the information provided is for educational purposes only, and is not intended as a substitute for professional services.
When giving talks to community groups, or when being interviewed by a news reporter, you can give general advice about typical ways to approach a given problem. Depending on the situation, you might qualify your statement by saying something like, “Many people find it helpful to…although it may not work for everyone.” A general rule of thumb is to avoid the word you and its variants when answering “What should I do?” questions.
By Pauline Wallin, PhD
This article is an excerpt from the online continuing education (CE) course:
Therapy Tidbits – May/June 2018 is a 1-hour online continuing education (CE) course comprised of select articles from the May/June 2018 issue of The National Psychologist, a private, independent bi-monthly newspaper intended to keep mental health professionals informed about practice issues. The articles included in this course are:
- New Prepayment Audits Strike Fear in Medicare Providers– Describes the difficulties practitioners are facing with when audited and explains the new method of auditing, ‘Targeted Probe and Education’
- APA Council Approves Reorganization – Describes the upcoming changes as the American Psychological Association Practice Organization is reorganized.
- Jail Opens Mental Treatment Unit – A brief look at how a Virginia City Jail is taking initiatives to support inmates’ mental health.
- APA Practice Guidelines Raise Questions – Identifies concerns for the newly proposed sets of practice guidelines.
- What is Obamacare Anyway? – An overview of Obamacare to date.
- When Being Too Helpful Can Backfire – Discusses the difference between ‘good customer service’ and a therapeutic relationship.
- MedPAC’s Latest Lead Balloon – An overview of the conflict surrounding the proposed change from Merit-based Incentive Payment System (MIPS) to the “Voluntary Value Program” (VVP).
- What Have We Learned from 30 years of School Shootings?– Highlights the use of amphetamine-based drugs and lack of quality mental health care as factors in school shootings.
- How to Handle Conflicts of Ethics and the Law – Provides examples of times when the Ethics Code conflicts with the law and offers strategies to resolve these conflicts.
- Psychologists Should Study Uses of Marijuana – Discusses the importance of seriously considering medical marijuana as a viable treatment for patients.
Course #11-20 | 2018 | 20 pages | 10 posttest questions
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Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).
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