Episode 2 Legal and Ethical issues in Holistic Therapy

Mar 30, 2021

How can you be true to yourself as a holistic therapist while providing ethical service to your clients? What is the difference between the scope of practice and the scope of competence? Are there ways you can set up your business to provide two different streams of service?

IN THIS PODCAST:

  • How to protect yourself against liability as a holistic therapist
  • Scope of practice vs scope of competence?
  • How can you expand your scope of competence?
  • How can you expand your therapy practice, ethically?

HOW TO PROTECT YOURSELF AGAINST LIABILITY AS A HOLISTIC THERAPIST

I found the American Counseling Association Code of Ethics where it discusses treatment modalities and thought this was a good place to start.

When providing services, counselors use techniques, procedures, modalities that are grounded in theory and/or have empirical and scientific foundation. Any kind of innovative techniques or procedures, modalities explaining the potential risks, benefits and potential ethical considerations of using these … you work to minimize any potential risk or harm when using these techniques as well as discussing the benefits.

What does this mean for holistic therapy and therapists?

The important thing that you have to do is if there is something you want to get into you, have to do your own research to really see what is out there.

I found a lot of research around reiki, essential oils, and yoga and their potential benefits. Although it is also as important to research any potential risks that you need to be aware of when working with your clients. For example, if you work with yoga you have to get a separate liability, even if your yoga practice is incredibly gentle, just in case.

sCOPE OF PRACTICE VS. SCOPE OF COMPETENCE

Scope of Practice

Scope of practice is essentially the explanation of what a practice does as a whole and places limits upon what can or can not be done in that profession. My board, which is the Licensed Clinical Mental Health Board, states that:

It defines that we can provide assessments, diagnose, provide treatment plans and individual counseling using psychotherapeutic techniques.

Scope of Competence

This is more individually based on what a clinician may do and is determined by one’s education, training, and experience.

So in summary: the scope of practice is more general in the therapeutic word but the scope of competence specifies what you yourself are competent in and can do best to treat.

HOW CAN YOU EXPAND YOUR SCOPE OF COMPETENCE

It takes a lot to really gain that competence, so again, it’s continuing that education and not only taking that one workshop … I always think that one thing would not be enough. You’ve got to talk to other people about it and be able to network with people who are also skilled in it so get some insights, consultation and supervision.

With the scope of competence, you can build on that by taking more classes and courses, building your experience, and training more often to broaden and strengthen yourself in the field you work in.

You can also read the relevant literature at the beginning to find the research out there that supports your findings. Try to find as much as you can in books, articles, and videos.

Your scope of practice is also not only what you do but what you say to clients during sessions. This means that you need to make sure that you are clear with how you explain things to them, that they sign an informed consent form.

HOW CAN YOU EXPAND YOUR THERAPY PRACTICE, ETHICALLY?

  1. Make a service you offering, such as tarot card reading, a separate part of your business. In this way, you can fulfill two parts: being a traditional therapist and offering holistic healing as a separate business whilst remaining ethical.
  2. Do some journaling: think about what is the best way you can add different integrated healing into your practice. What are you called to do? How can you weave this in somehow so that you feel you are not disregarding your passions and your calling.

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Resources Mentioned And Useful Links:

Transcript

[CHRIS McDONALD]

The Holistic Counseling Podcast is part of the Practice of the Practice network, a network of podcasts seeking to help you market and grow your business and yourself. To hear other podcasts like Behind the Bite, Full of Shift and Impact Driven Leader, go to www.practiceofthepractice.com/network.

Welcome to the Holistic Counseling Podcast, where you discover diverse wellness modalities, advice on growing your integrative practice, and grow confidence in being your unique self. I'm your host, Chris McDonald. I'm so glad you're here for the journey.

Welcome to episode two of the Holistic Counseling Podcast. I'm your host. Chris McDonald. Today's show we'll bring in discussion regarding scope of practice versus scope of competence and protecting yourself from liability as a holistic therapist. As I researched this topic, I did kind of pull me down into a rabbit hole as there are different recommendations for states, there's different recommendations based on the type of therapist or counselor you are. But I think I pulled it together and was able to give you some general guidelines that will cover most of you, but just to be safe, make sure you do check with your particular licensing board as well as liability insurance for guidelines specific to you. Before we get started, I just wanted to double check too, to see if you're able to come up with some kind of ritual to do right before you start listening to this podcast.

I know it's not always possible as you may be doing something else, but if you're able just to have a quiet space. I know for those that didn't listen to episode one, I did find a ritual for myself to light a candle, to have some crystals out and have my salt lamp going, just to kind of give us soothing space and do some breath work before I get started. And again, this can be part of your self-care. Take care of you. So let's get to it. So what I found first was the American Counseling Association code of ethics C7, which says treatment modalities. I thought this would probably be a good place to start. So scientific basis for treatment. So when providing services, counselors use techniques, procedures, modalities that are grounded in theory, and or have empirical or scientific foundation and any kind of innovative techniques, procedures, modalities explaining the potential risks, benefits, and ethical considerations in using these, which should sound familiar to you as that's usually part of informed consent for general counseling.

Also that you work to minimize any potential risks or harm when using these techniques as well as discussing the benefits. Again, it kind of goes into the same thing about that. So what does that mean for holistic therapy and therapists? The important thing that you're going to have to do is if there's something you want to get into, and hopefully if you do get some training at something, they will provide you with some of this. But if not, you got to do your own research to really see what's out there, because I did find that there are, is research for things that you never even thought. So I did find some research for Reiki, that there are some benefits out there for helping with mental health and also essential oils. There's actually a lot for growing research with essential oils, about helping with treat anxiety and depression, changing mood, which is so amazing and yoga. There's lots of research about the potential benefits of that.

Now looking on the side of risk. So let's start with yoga. If you're going to get into yoga and therapy, you do have to get a separate policy to cover yourself for liability-wise because anytime you're doing anything physical or teaching something physical, of course you have to be careful, even though what I do is more gentle yoga, a lot less risk, still have to cover yourself just in case. And it wasn't that much. It really didn't add much to my policy as far as cost, but of course the big cost, if you would get sued would be huge. So it is worth every sign of having liability insurance for that. And yoga too obviously can cause, depending on some people and their issues. So you have to be really careful that people don't get injured.

And that is something that you have to explain to clients, the risks and benefits as well and the informed consent. So being careful with that, being upfront and of course the only thing I could think of too with essential oils is some people are sensitive to that. Even if you do put the central oil into some kind of base, like coconut oil to make sure it's not too strong for the skin, some people can be sensitive and have a reaction. So you do have to be cautious with some of these things that you do, or if you just keep it as an essential oil as aromatherapy, just to smell it, that's different. But if you're actually allowing clients to put essential oils on their skin, then that's of course a risk of rash or sensitivity. You know, some people are much more sensitive to things than others. So just keeping that in mind.

So let's go into scope of practice. What does that mean? Scope of practice is provided in law that delineates the profession, what they do as a whole and places limits upon or confines the breadth of functions of people in that profession, what you may lawfully perform for example. So I looked up my board, which is the Licensed Clinical Mental Health Counselors Board and it defines that can provide assessments, diagnose, provide treatment plans, individual counseling, using psychotherapeutic techniques. Okay, that general kind of statement. And what's the difference between scope of practice versus scope of competence. And to be honest, I didn't know there were two of them. So this has helped me to learn this as well. I think this is really important for everybody to really be sure they are clear about this because there's two different things.

Okay. Scope of competence is more individually based on what a commission may do and is determined by one's education, training and experience. So scope of practice, again, going back to that as general guidelines that yes, you can provide counseling, but scope of competence doesn't mean you're competent in every single thing under the sun. For example, let's say that you're working for an agency and they refer somebody that has severe PTSD and you've never been trained, you have no experience, no supervision. That would be out of your range of competence. So the best thing to do in those kinds of situations of course, is to go to your supervisor and say, "Hey, I have no experience, no training, no supervision with this. I need to refer this person out." It can be difficult at a community mental health center because I've been there and they want you to see everybody, but you do got to cover yourself because you don't want to get in and trying to fake it when you don't know what you're doing.

And again, part of this too, is that you're not competent after one workshop or course. I think some people think, oh, so I took this one day course. I'm good, right? No. Always remember that you need further education, further training, experience in supervision to be considered competent. And let's just say that you do learn something new and something goes awry. And you have a lawsuit. They're going to see, well, are you competent in this modality? And maybe they're going to say, oh, she's at one workshop. That's not enough. So you do need further education, further training and experience and supervision. So just to give you an example, when I did training for brainspotting a year ago, I started in January, got the first phase, I did some group supervision, did some continual learning on my own, did a follow-up workshop to got my second training last November, did another follow-up workshop and another training this past January.

So it's kind of keeping the trainings in mind, the experience of supervision. And of course I was practicing all throughout last year. So knowing that's what can bring that level of competence. And as far as out of scope of practice, let's say that you have a client that comes into your office and they're like, "Oh my God, my shoulders are killing me. I'm in so much pain and I have so much tension." And you, maybe you learned some massage therapy from your boyfriend who, or a friend who showed you some skills and you're like, "Wow, could I just try to use some of that to help them relax in session as a therapist?" And they're coming to see you for mental health therapy. That is a big fat no. So knowing that, that is in your scope of practice and out of your scope of competence, even if you've practiced and a friend just casually showed you, don't do it. Unless you have that massage therapist certification or licensure, you got to make sure that you are doing what is within your scope of practice and scope of competence. That is definitely not in of course, licensed clinical mental health counselor, or social worker, I'm sure, massage therapy. Just want to give you some examples to help clarify this.

So the next question is how does one person once licensed expand her scope of competence in order to acquire what's necessary to feel that? Okay, I got this competence. It takes a whole lot, really to really gain that competence. So again, continuing that education, not just taking that one workshop or whatever it is that maybe you read an article. That's not enough, of course. I always think that one thing would not be enough. You got to be able to talk to other people about it and be able to network with people who also are skilled in these, just to kind of get some insights and consultation and supervision. Reading the relevant literature, like I said, at the beginning to really do your due diligence to find out what is the research that's out there that supports this?

Looking at relevant videos. I know I did some of that as well to learn from other people, reading information online, trying to find as much as you can, books and actually scheduling that time for supervision. I know we just mentioned that, but that's so, I can't even begin to tell you how important that is. And I find, and again, just remembering supervision is not just for initially licensed people. I think people are like, "Good, I'm good to go. I'm fully licensed. I don't need any more supervision. Bye." No supervision should be part of your career as a clinician, continuing after full licensure. And I think, especially when you learn something new, getting that supervision piece, I have learned so much, so many things that are never going to be part of a course, especially if you go to different, I find different people.

So I went to a different supervisor than the one that taught the brainspotting course, just as an example and she had totally different ways of looking at things and different perspectives and different ways to use it, treatment modalities. So definitely seek out different people. I know there are some peer consultation groups as well. I have done those in the past, just for general therapy and counseling. That is just an invaluable resource and information. And of course that's a support for you because a lot of the mental health therapists out there, social workers out here we're on our own. It can get pretty isolating. So in addition to increasing your scope of competence, that also to give you some general support, just some other kind of ways to connect with others in the field, especially if you're doing all tele-health. It is very isolating more so than when we used to just do in office all the time. So making sure to connect with others.

Another point, working within scope of practice isn't just about what you do. It can be also about what you say to clients. So what do I mean by that? So making sure that you're clear when discussing with clients, but also in the form consent, having their signature and date, not to exaggerate your training. So if you do take, let's say Reiki, one training, you don't say that, "Oh, I'm a Reiki master." Don't do that. So be honest. You need to be upfront of what your scope of competence is and where you are with that as well as your credentials, whatever that may be. So you can never want to misrepresent yourself because that's going to get you in a whole lot of hot water if something happened. And of course that's very unethical, being honest and having that, having a very clear in your informed consent, again, the risk benefits and what it is you do. And I have a whole extra waiver actually in my forms that I give to new clients about yoga and the risks, benefits, and potential for injury, which is pretty low based on what I do with clients but you still got to do that. You still got to protect yourself. I hope this makes a lot of sense and this brings more clarity for you on the difference between scope of practice and scope of competence, as well as covering yourself from liability.

I want to make one more point to you before this episode ends. I want to share a couple of other ideas about what you can do to integrate and, I'm not going to say bypass the ethics of research, but to find other ways to work with that. So I don't want anyone after this episode to be like, "Oh, now I can't do what I want to do with the holistic strategies because I want to be an ethical therapist." The point is you can be. Now here's point 1, let's say that you want to do tarot cards readings for example, or some work with angels and of course that's probably not research-based. One thing you could do is to make it a separate part of your business. So instead of seeing some clients for therapy and the holistic strategy, like tarot cards or angelic light healing or crystals, then that part of your business you'd be the holistic healer part only and you would just use those strategies with those clients.

Does that make sense? To have two separate parts of your business, in that way you're fulfilling what you're called to do, which is the holistic healer part, but you're still doing therapy and being ethical about it too. Or here's another way to look at this as well. I had a client a few years ago who I struggled to help her with a lot of trauma that was coming up. She was a teenager and it was really difficult for her. She had all these repressed memories that suddenly started to surface. We had a really great relationship and I'm not sure that's what really helped her to start to feel like she was in a safe place and to reveal these difficult memories. So what I did was combining things like my yoga and did some energy healing breath work as well as trauma focused CBT.

So this is another option to combine your techniques, which I think most people do anyways. Usually we're not just doing just CBD or just regular talk therapy. So usually we're combining, but think of it that way. So I called it the trifecta for her. So with yoga energy healing and trauma focused CBT, there you go. And I laughed with her about that. I said, "You're getting all kinds of healing from all different ways." She was very open about it. And I got to tell you doing the trifecta with her was amazing. She really had some positive results and her parents noticed, and she did exceptionally well with that treatment. So just keep that in mind, this is not, this episode is not meant to discourage anyone from doing holistic strategies, but rather to encourage you to think about, think outside the box a little bit, that may be for you it could be just another part of your business.

Or combining it for another trifecta or maybe two different treatments that includes energy healing or other things that may not be as research-based, but you're still providing a lot of this great service and help to these clients and doing the best that you can as a therapist. So just really reflect on that. And maybe another thing you could do is to think about what can I journal about tonight? What would be something you could write down to figure out what is the best way for me to add this to my therapy practice? What calls to you from what I said today? How can you do this to really integrate it and feel in your soul, because what are you called to do first off? And then what is the best way for you to really think about this and integrate and weave it in somehow so that you feel you're not taking yourself out of it and saying, "Nope, that's not for me. I guess I can't do this," but then feeling discouraged and sad that you can't do what you're called to do. I hope this all makes sense to you.

I know it's a lot to think about. I will post some links in the show notes with some of the research I found as well as additional information on scope of practice and scope of competence to help you further understand this so that you're totally clear. But I want to thank you for tuning in today on this topic. I know it's not the most exciting of episodes, but I think it's one that is so important that we don't want to skip this. We want to make sure that we're doing the right things for the safety of our clients.

And be sure to listen next week, as I share tips for integrating holistic strategies into therapy, as well as how to develop your own personal practice. And remember to subscribe, rate, and review to help expand our listeners. And again, this is Chris McDonald sending each one of you much light and love. Until next time, take care.

If you're loving the show, will you rate review and subscribe on your favorite podcast platform? We just started this and that helps other people find this show. Also, if you're feeling uncertain about your modalities and you want to build your confidence to be your unique self, why don't you to join my free email course, Becoming a Holistic Counselor over holisticcounselingpodcast.com. In my Becoming a Holistic Counselor course, you'll get tips for adding integrative care into your practice, what training you need and don't, and the know-how to attract your ideal holistic clients. If this sounds like the direction you are headed, sign up at holisticcounselingpodcast.com.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.

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