Badass Therapists Building Practices That Thrive
Welcome to Badass Therapists Building Practices That Thrive, the ultimate resource for mental health professionals ready to step into their power, grow their practices, and create a career they love. I'm Dr. Kate Walker, a Texas LPC/LMFT Supervisor, author, and business strategist who's here to show you the path to success.
Formerly Texas Counselors Creating Badass Businesses, we’ve rebranded because, well, we’re way too big for Texas now! This community of badass therapists is growing nationwide, and we’re here to help you create a career and practice you love, no matter where you are.
Every week, you'll get practical advice, proven strategies, and motivation to help you build a thriving practice—one that gives you the freedom to live your life on your terms. From mastering marketing to designing scalable systems and becoming a clinical supervisor, this podcast is your roadmap to leveling up without burnout.
Hit subscribe and get ready to unlock your badass potential. Your thriving practice starts now!
Badass Therapists Building Practices That Thrive
139 Navigating Ethics in Play Therapy With Lynn McLean LCSW-S
Curious about the world of play therapy? Join us in an enlightening discussion where Lynn, a seasoned play therapist, reveals the ethical dimensions and best practices integral to this unique field. We kick off by exploring Lynn's journey, filled with passion for transforming children's therapy through play. As the episode unfolds, we tackle some critical topics like the ethical responsibilities of therapists, the importance of obtaining informed consent from caregivers, and how to document therapy sessions effectively.
Lynn brings her expertise to the forefront, sharing vital insights on navigating complex family dynamics and the legal guidelines governing play therapy. Every decision counts in child therapy, and Lynn emphasizes that understanding these ethical nuances is crucial for the safety and well-being of the children and their families involved.
Listeners will gain valuable strategies for balancing the needs of the child with those of parents, understanding the limits of confidentiality, and maintaining a clear focus on the best interests of the child. Whether you’re an experienced therapist or exploring the field, this episode serves as a comprehensive guide to enhancing your skills and knowledge in play therapy.
Equip yourself with resources and inspire meaningful change in your practice as you listen to Lynn's expert advice. Every child deserves the best care possible, and understand how to provide that is what this episode is all about! Don't miss out—tune in, engage with our community, and elevate your practice today!
Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.
Thank you, and I'm super excited about our expert tonight and I will be really upset with myself if I have not hit record. Okay, I am recording. Okay, good deal. So a little housekeeping before we get started. If you have not been to one of our webinars, if you would just take a moment and grab the chat. If you click on the chat you can actually pop it out so that it's out there at all times and the way we are now doing our documentation, your CE certificate, is. We have broken up with email and that means you already have your certificate. It's in your Kate Walker training profile. You simply log in, go to this webinar and you can download the certificate. But you will need the unique number for this webinar and the only way you can get that is if you fill out the Google form. So see, we still got you, we still got some accountability here. So in a few moments my assistant, jennifer Fairchild, is going to put the Google form link into the chat. I highly recommend you grab that as soon as she puts it in there, click it so that the tab is open, and we all know you keep your tabs open all day long anyway. So one more is not going to kill you. Keep that open and then you can fill it out later. You don't even have to fill it out right now. So, without further ado.
Speaker 1:I have known Lynn for what three years and I have watched her create things with her business Houston Family Therapy Associates surrounding her love of play therapy. Now, I'm always trying to give her the push into doing things like oh, I don't know, offering courses. Did you just spit out your coffee? I just made you laugh, didn't I? So this is something. I don't know how often you get to do this, lynn, but I'm so excited because she's just funny. You're going to love her and I told her by the end of this, y'all are going to be best friends. So no pressure, lynn. So, lynn, go ahead and unmute and if y'all again use the chat function to ask your questions, jennifer and I are going to monitor the chat and we will toss your questions to Lynn. So, lynn, thank you so much for being here.
Speaker 2:I'm so happy to be here. Thanks for the push and, yeah, no pressure. Y'all, you need to love me Real quick. Some of you, I already know, do some play therapy, or you have people on your staffs who do Really quick show of hands. Who is doing play therapy already Okay, fair number and who are thinking about adding it to their practice. Okay, a few, okay.
Speaker 2:So we're going to be talking about both of those options and I'm going to share my screen with the slideshow. What we're going to do, I don't know about y'all, but I have a million handouts. So about two or three slides in there's going to be a QR code. I'll pause there. You can grab the handouts if you decide you want them for the resources. There's not going to be anything really groundbreaking on here, but I just want to let you know you don't have them, because God knows how many of those three slides per page do we need in our lives.
Speaker 2:All right, so we are going to be spending an hour together talking about ethics and play therapy together, talking about ethics and play therapy, and what we're going to be focusing on is best practices as the Association for Play Therapy defines them. Why should you listen to me. So I am a licensed clinical social worker and supervisor and a registered play therapist supervisor. Those of you who know about play therapy know that the Association for Play Therapy offers this certification for us. I went to the University of Houston Graduate College of Social Work and I got amazing training and supervision there. I was privileged to be actually in a small weekly play therapy seminar at Texas Children's and I was inspired to start one of my own at Small Steps Nurturing Center. And then I decided to go on and take the leap and I'm an APT approved continuing education provider and I'm launching that business this year with there will be an in-person and online seminar that will be next month, so y'all can tune in and hopefully we can keep doing those continuing education hours for everybody working on that RPT.
Speaker 2:So this is going to be down and dirty and you know we're not going to get through it all like we're just not, because there's so many laws, there's so many codes of ethics, there's so many best practices. But we're going to do our best and I'm going to save a little time at the end for question and answers. So, as you have them, just jot them down, or they're going to be monitoring the chat too, so they'll help me know if you have them, okay. So here is where I say if you want to grab the slides, this little QR code is going to get them to you. You'll give me your email and then you'll get them and you'll just have them in case you want them. I think it's mainly the resources, honestly, that I want you to be able to have. If you need help, jennifer, kate, are monitoring the chat. You know what's up to get your certificate, fill out your Google form and we will be looking for whatever help you need. Okay, and I'm going to go on. Hopefully everybody's grabbed that if they need it.
Speaker 2:Okay, here's what we're going to be doing. We're going to be identifying ethics requirements in providing play therapy First, most importantly, under Texas licensing laws, because we have to follow the law according to each of our licenses. We're going to talk about best practices for providing play therapy according to the Association for Play Therapy. They're very in-depth we're not going to get to all of them, which you'll thank me for that, actually and we're going to talk about the implications of providing play therapy and mental health practices and think about some action plans for doing that. So, as I just mentioned, we all are bound by Texas statutes and rules and they really govern our licensure. You already know that, and providing child therapy is pretty complicated, so not that providing therapy to taller people is not, but when you have a child, there's all these different kinds of things to think about. So we're going to be talking about all of that and also we're going to be talking about the Association for Play Therapy and how they give us additional guidelines and best practices for our use of play therapy in the treatment room. There also, as you know, are national professional standards and these really hold us to a pretty high standard. So, as a social worker, for example, nasw always really helps me out.
Speaker 2:Now, if you're like me, I always have a million tabs open on Chrome and all the rules and best practices, and so I just put together a little desktop reference if you want it. This is the QR code for that. It has links to the BHEC rules, the professional codes and to the association for play therapy best practices document, and that way you're not printing them all out or flipping from tab to tab. So hopefully this will be helpful to you if you want to have them. You already know the rules are not identical for each profession. They're fairly similar. Kate is definitely the expert in all of those kinds of BHEC changes and you just want to be sure that you're following the rules for your license.
Speaker 2:So since we're in Texas, we're going to talk about what our state requirements are. Y'all already know this. You're ethical practitioners. But since we're talking about ethics, we do need to talk about the fact that the Behavioral Health Executive Council, as y'all know, promulgate these rules for us. They set out the requirements that we need to follow for our licensure, for the ethical practice under those licenses, for the protection of our clients, and they also set out ideas for and what we're supposed to do for supervision, consultation. They also the rule books, which are so much more convenient than they used to be. They actually offer other relevant sections. So, for example, chapter 611, which governs mental health records and talks about how we're supposed to handle custody matters. They also, as a great change from what used to happen, they're regularly updated and they actually point out the amendments that they've made. So I do love that and am so grateful for BHEC about how they're doing those things. And then, obviously, y'all know the big professional associations have their own codes of ethics to add on to our state licensure standards. So ACA does this? Nasw and AAMFT these really hold us to the highest possible standard for our work and when I'm in doubt, honestly, that NASW code really holds me to a great standard and I think that having a strong relationship with those codes of ethics is a strong ethical foundation. So I alluded to this before.
Speaker 2:Those of you who already treat kids, or those of you who are considering it, know that there are different ethical and legal considerations when we're treating children versus adults. And here's where I call out one of the attendees, dr Terry Sartor. This book is really one of the best resources. This is in the resources guide really one of the best resources. This is in the resources guide. It's called Ethical and Legal Issues in Counseling Children and Adolescents. It walks you through a number of different scenarios and we will talk about an ethical decision-making model that these folks put together. So it's Dr Sartor and also Bill McHenry and Jim McHenry are the editors of this book and it is a very strong resource for us.
Speaker 2:So, in general, things to think about are that minors cannot consent to treatment. They can assent to treatment, and we'll talk about that. So we need an authorized parent or custodial guardian to give their legal consent. We are required, of course, to be sure that the authorized custodial caregiver of this child is giving consent to the treatment, so that's covered in our licensing laws.
Speaker 2:Another unique consideration for us as we talk about treating kids is the issue of confidentiality, so we are bound to the child client for confidentiality and their caregivers, which we're going to talk about everybody as caregivers, whether they're parents, custodial guardians, all of that. They also, though, are able to receive some information, so we really need to think about all of that. We also need to govern appropriate confidentiality and therapeutic care when we are communicating with parents and caregivers, and what are the limits of confidentiality? What should we know about them and who are we going to share information with? Kids don't exist outside of the grownups in their lives, so if we have an adult come in, they're able to legally give consent, they're able to address issues with us. We may consult with some professionals, but for the most part, the adult is able to self-report. We're able to act on what they're doing With kids. They can't exist, really, outside of their relationship with the adults who are in charge of them and the Association for Play Therapy thankfully, really talks about this and we're going to talk more about it.
Speaker 2:So just some ideas of all the different key players. When we're talking about treating kids, of course we have the client, who's in the middle, and that's our focus. We also have we add us to the mix their parents and caregivers. Often there are co-treating professionals, so there might be occupational therapists, speech pathologists, teachers play a very large part in kids' lives. There can be non-custodial caregivers, nannies, grandparents, all kinds of other things. There can be community organizations involved in treating kids, so they might get resources from the community. There may be legal implications with CPS or other professional agencies and there can be past treating professionals that we need to consider as we are coordinating care and providing the best possible care for kids. So it can be a complicated set of players to consider, but keeping the client in mind is really so important. So that's where we're grateful for, and sometimes honestly daunted by, the Association for Play Therapy's best practices.
Speaker 2:In a nutshell, this is a 33-page document. It's been around for a while, so these best practices have been published for more than 18 years and they're reviewed frequently five times since their initial publication. They will be reviewed again this year. So make a date with your APT best practices to check out the updates on what they're recommending. The awareness of these play therapy best practices are really recommended, whether or not you are certified as a registered play therapist by APT. If you're working with kids, they really recommend that you be aware of these and they are respectful of us in that complicated situation I just talked about. It's important to know y'all are smart people and you know this already. It's important to know y'all are smart people and you know this already. But these are an adjunct to, not a replacement for, your legally required practices. So APT is not going to be in charge of your license and these are going to be, over and above, to treat kids in the best possible way.
Speaker 2:According to the Association for Play Therapy, there are many, many sections. This is a dense little document. We are really going to focus most for this short time together on practice documents and keeping strong documentation and those kinds of similar small focuses. But I really recommend, if you are doing plate therapy, hop in. They cover supervision, consultation, collaboration all kinds of great topics for us. Okay.
Speaker 2:So generally, if we look at BHEC versus APT, bhec will offer us guidelines for ethical documentation. It's important for us to pay attention to these. We're required by law to include them. Not surprisingly, apt goes recommends very specific play therapy documentation. I will tell you, I've gone through these several times and every time I'm like I need to add that to my note forms.
Speaker 2:So that's the bad news and the good news about this topic. The bad news is I don't have a one size fits all solution for you. The bad news is I don't have a one-size-fits-all solution for you. The good news is that there are really strong recommendations and ethical decision-making models and you have this on your radar now, so you'll know. Okay, I don't exactly remember all the ins and outs, but I know where to look to really refine my practice, all right. Also, bhac sets out the ethical and legal requirements for consent for the treatment and of any client, but especially minors, and it requires treatment plans, as you all know. Apt goes more in-depth and talks about involving caregivers in the treatment planning, and it talks about maintaining confidentiality for our minor clients. Bhec also sets out pretty strong ethical and legal requirements in technology use and APT offers more detailed guidelines for the use of technology in play therapy, which might sound like an oxymoron, but we do actually sometimes are able to use technology and there are best practices for doing that, especially with kids.
Speaker 2:So, just to put this on your radar, there are a number of different sections and these are what I alluded to earlier. So, to the degree that you really want to dive in, maybe you make a date every I don't know few weeks to go in and review one of these sections and look at ways that you could beef up your practice with some of these ideas. Or, if you're like you know what, I am consulting with a group of professionals and I'm not really sure how to organize this. Maybe it's a complicated case. You know now that there are, there's a whole section on relationships with other professionals and how to involve them in your treatment of a child. So I'm just putting these on here just to just to let you know, put them on the map for you and you can take a look at those when you have time or if you feel like you need to.
Speaker 2:Okay, so APT tells us that our commitment and responsibilities to the client primarily involve providing treatment that respects the dignity and uniqueness and supports the best interest and welfare of the client. May include referral to adjunct treatment of significant others in a client's life. Sometimes we don't really encounter that when we're working with taller people, but with kids it can be a little more common. I don't know how many of you child therapists I don't know how many times you're like, oh okay, we need to get a couples therapist in this network. So it's those kinds of things that APT really addresses and I'm always so grateful to them for including that.
Speaker 2:An important thing to keep in mind is that when we're treating minors, our primary responsibility is to the child and not to the caregivers, and that's a really big deal to me and to the child therapists that I know. And we do have responsibility to caregivers that's not to say we have none, but our primary is to that client, the child client, and their confidentiality. They also encourage us a PT does does to establish and follow therapeutic treatment plans that are collaborative with, and understandable by, the client and the caregivers. So I don't know how many of y'all think about, um, how to cover a treatment plan with a four-year-old, how to be sure that you're being developmentally responsive to what their treatment goals are, and it's just something to think about. It is not always easy, but it is certainly best practices. We want to have our treatment goals, treatment plans reviewed regularly APT recommends every 90 days and have a supportive treatment plan that continues to engage the client and the caregivers. So what we tell parents in our practice is that 90% of the value that their child's going to get from treatment is going to be based on what they do outside of session. So we're pretty bossy about making recommendations to parents so that they can achieve these treatment goals, and we really try to support parents in that. All right.
Speaker 2:So documentation obviously should include all of your legal requirements, and, as I'm going through the documentation, what I would recommend for you is to think about where in your documentation this might already be and where you might put it in. So maybe you just take a little note like oh yeah, I could add another checkbox here or there, because I think it's a very complicated set of documentation practices. Reviewing some of these lists reminds me sometimes of Dr D Ray, who published Advanced Child-Centered Play Therapy, and there's a list of competencies that she encourages play therapists to have, and the list is so comprehensive that every time I review it, oh my gosh, how in the world am I ever going to do all of this. You don't have to do all of it. The goal is always just to be working toward mastering the things that are important and then maybe you tweak Again. Every time I go through these I'm like, oh, I could add this checkbox or that to my note-taking and I just think it's really, it's a goal, it's a process, it's not an end result. You don't have to have done all of these already. Okay, oops, I should have talked.
Speaker 2:So we want a developmental history for them and this can be in your intake assessment. You want it to be very thorough, as much as you can understand the implications of what you're asking about and consider what their gender pronouns are going to be, their cultural affiliation, obviously, the presenting problems. Think about the current developmental level of functioning. One of the key requirements of us as play therapists is to be highly aware of developmentally appropriate behavior, because if a four-year-old, for example, is not a highly focused, very adept, executive, functioning human, that's developmentally appropriate. That's their job. So part of our job the APT best practices really prompts us to be super aware of developmental history and expectations and being an educator for caregivers about that. The documentation should also include the level of family functioning and environmental assessment includes your long and short-term goals of treatment and the conditions for a termination assessment and treatment review. Most of you already know when you have informed consent, one of the things to include in that at the beginning of treatment is how treatment will conclude, and beginning that with the parent at the beginning is a best practice because a lot of times it's hard for parents to discuss, to tolerate, to plan for termination of treatment. So that's something for us to think about and help support caregivers in that as we go along.
Speaker 2:We also want to include in your documentation their overall functioning and session observed play themes, the materials that they use and changes. Changes are a big deal. So changes in thought process, their mood or affect their play themes, intensity of their play, their behavior. I'm not going to lie, I've been doing this a long time. Sometimes I don't know exactly what it means, but I know to pay attention to it and I have a form in my note taking to pay attention to overall shifts, changes. I know when things have never done this before and all of that is really important.
Speaker 2:We also, and as play therapists, this is it's the waiting room, it's the handoff right, it's that transition. So clinically significant observations of clients with their significant others. I know those of you who see kids. We in the waiting room. You see a difference if mom brings or dad brings, or nanny or grandparents, and any of that that's clinically significant. You want to chart that. You also can have and should have in your notes clinically significant observations of the significant others when they're seen separately from the client. So, for example, it's not uncommon for us to meet with parents and have one parent if it's virtual, like literally on the side of the screen, or turned completely away from the therapist all of which is clinically significant, just indicating the level of involvement. I've also heard parents making comments in the waiting area.
Speaker 2:Not all of it is clinically significant, but some of it is, and so that's the part that you definitely want to include in your documentation. You also should include graphic images that are relevant to their behavior and goals. So this would be examples of sketches of sand trays or photographs is very common when they're deemed clinically appropriate or for a justified rationale, like supervision. If you're attaining your registered play therapy certification, you know you have to have your supervisor watch a video of a play session. Obviously, all of that would be only with consent from caregivers, also verbal and nonverbal expressions relevant to their behavior and their goals. So all of these should be in your documentation and just thinking about the best way to do that, because obviously all of it has to be HIPAA compliant confidential.
Speaker 2:Another really important part of doing play therapy seeing kids is to think about touch and document when it's used therapeutically and or non-therapeutically. And APT talks about the fact that therapeutic or non-sexual touch can definitely have therapeutic value, but it should be used very mindfully, with a lot of education, supervision and consultation. And again, apt gives us another great resource with their paper on touch. If you're working with kids and you haven't reviewed it recently, I really recommend that you take a look at that. Also. It comes up with kids.
Speaker 2:We need to recognize that clients who have been sexually abused or inappropriately sexualized may initiate sexualized play or inappropriate touching of the play therapist and when that happens, we need to take appropriate measures to help them understand that it's not appropriate.
Speaker 2:And definitely you need to document this, discuss the incident and the intervention with the clients and or their caregivers, engage in peer consultation, consult your supervisor, do whatever you need to as soon as it occurs. It's an important part of working with kids in an appropriate way, and it's something that we all should be aware of, and it's something that we all should be aware of. We also, obviously, should include any suicidal or homicidal intent. For those of you that don't work with kids, it may be surprising to hear about this in an association for play therapy recommendation, and unfortunately it does happen, and so I'm documenting carefully about the incident, the ideation, the plan and what the recommendations and steps taken to ensure the client's safety, and this could include referral to other services, consultation with other service providers, hospitalization. All of that should be in your notes. And again, seek consultation, seek supervision if you need it.
Speaker 1:And we have a question. Okay, Question is what if one of the parents are the abusers?
Speaker 2:The question is, what if one of the parents are the abusers? Yeah, so you're required. We're all mandated reporters, so we're required to report to Children's Protective Services within 48 hours of learning of the abuse. Ideally, the family, the caregivers, should be involved, but not if that endangers the child.
Speaker 1:Does that answer the question? It was mentioned that we need to share with caregivers. So, sabina, do you want to unmute? You'll be on the recording. So if you don't want to, that's okay, or if you want to clarify there. Lynn, do you know what she means there?
Speaker 3:Yeah, I would not share with caregivers if you believe it will endanger the child know, when you notice that there's some initiation of inappropriate sexual like touching from the child, um, if we want to initiate first with the caregivers or just hold off and just kind of wondering how to break that down even more.
Speaker 2:Got it, got it, got it.
Speaker 2:And this is a delicate situation and I think that, um, part of what you need to think about is protection of your own role as an adult in a room with the child, and that's part of the reason why APT really recommends letting caregivers know what has happened. But I would recommend, if you have a lot of concerns about the safety of the child, again consulting, supervising and keeping in mind that 48-hour window. If you believe that somehow that inappropriate sexualized touching indicates or may be part of an outcry, does that make sense? I think so. So, just to clarify, you're saying that if there's happening and I will bring it up with parents in a very general way, so this is nothing.
Speaker 2:This is not an outcry, this is nothing that the child has told me or acted out something developmentally outside of where they should be. But I've talked to parents and said in a pretty general way so I'm wondering about any inappropriate touching or access. Who has access to this child? Because we don't know, we don't know, and so sometimes just involving them in the conversation can help in a. That would be in a general way. Again, not if there is an outcry.
Speaker 1:We have a follow up in the chat. Okay, so share with caregivers. When a child touches the therapist, this would also destigmatize touch with parents. Many jump to abuse. Sometimes kids are touching out of exploration as well. Is this something you discuss with parents?
Speaker 2:Yes, the best practices do recommend that you discuss it, and this is where your knowledge of developmentally appropriate information and the appropriate development for their age comes into play. And I agree, for their age comes into play and I agree, the vast majority of times that have involved touch in the playroom have definitely not been inappropriate or sexualized in nature, and it is important to document them and you can discuss them with parents. But if and I don't Um, but if and I don't, you can just sometimes get a feeling about a child's play and that is something also to pay attention to internally, document in a way that is helpful to you and, if necessary, yeah, discuss it with the caregivers. Okay, okay, apt also talks to us about um, including progress or barriers towards goals. Here's where I remind us all that anything that are in your notes should be you should be willing to have them read out loud in a court of law in front of caregivers. So you want to be sure that if you see parents' failure to follow recommendations as a barrier toward a treatment goal, for example probably that's never happened to anybody who hears this you just want to be clear about how you're documenting that. That protocol would be okay for you. You also want to document interventions or coordination with significant others, and this would be family members, teachers, pediatricians, psychiatrists, and this would be in or out of actual session time. So adjunct therapy, referrals, I mean that's.
Speaker 2:Another part of treating kids is we have a lot of other people that have a lot of information about these little humans, and so there's a lot of outside consultation time and all of that should be documented. And obviously all of that would only happen with appropriate release of information. Also, as much as you can document medications, medication changes, any side effects. Sometimes you see kids come in with a lot of mood changes and parent may report to you that they've just had an increase in a medication or a reduction. Also, you want to document any rationale for inactions taken with regard to complying with your laws. So, for example, your informed consent form, your, your releases of information, if you have a telemental health consent form, all of those things should be in your records. They should all be there, consent to videotape if you need to for supervision. And after you've done all of this, all of it should be safeguarded and kept with all required legal guidelines, so like HIPAA. So you've done all these things and I don't, I don't know about you, but again I'm like, okay, yep, I got that, no need to add that. So that's a lot.
Speaker 2:So, thinking about the rights of our clients, minors they can't legally give consent, but APT tells us that we should work to obtain assent from minor clients to treatment. I don't think many of us actually do this and again I challenge you to think about gaining assent from a five-year-old to treatment. How do you developmentally explain to them what's going on, also provide informed consent to them and their rights to confidentiality and limits to it. So this is again where you flex your knowledge, your developmental knowledge muscles, because helping a child understand what they're agreeing to, what you're going to keep confidential and what you're not going to be able to.
Speaker 2:There are cases some of you may do court appointed treatment and really best practice is to tell that child from the jump. You know what. This is not all going to be secret. Usually what you say or what you play is just going to be between you and me, unless I thought you weren't safe. But in the case you know you're going to have to turn over your notes. You can't tell him that. So you can tell him. You know I will be letting your mom's lawyer know about this, or it's really. Kids deserve to know those things and it's one of the I will say for me it's one of the hardest parts of that kind of client, that kind of job.
Speaker 2:Also, consider the therapeutic relationship when you are thinking about treating multiple clients. So there are some play therapists and I don't have I'm not saying there's a right or wrong with any of this who absolutely refuse to ever consider treating clients who are in a relationship with one another, for example, members of the same family, cousins, friends. Really consider carefully the advantages and disadvantages of doing this. All parties should be aware of relationships and confidentiality and obviously confidentiality should be protected and extended to everybody who receives the services and not just the identified client. So in this case you wouldn't tell you know cousin's mom what's going on with their niece or nephew.
Speaker 2:You have to really be sure, if you are going to do this, that you're really carefully considering what it's like and keep very tight boundaries. But there are times that it is you may feel okay about doing it. Obviously, I've already talked about termination. It actually gives caregivers hope when we talk about termination at the beginning of treatment, because there's this idea that it's not going to go on forever. Their kid is not always going to have to be in therapy. Listen, I love my job but if I'm doing it right, I'm going to be able to graduate your child and we're going to hopefully talk about this plan for it and graduate them with them in the loop. Obviously, you don't abandon them, you don't neglect them.
Speaker 2:If you see that treatment is not effective or treatment goals are just not being met, refer out as you need to Involve the children in discussion and preparation. I think those of us who see kids just take this like. Of course you would do that, but it's really hard for adults sometimes to consider their child saying goodbye to somebody who's been important in their lives. So be aware that the adults might have some really strong feelings about this. Sometimes the adults make decisions about ending treatment for them and the child is maybe not ready, definitely not on board. So, collaboration with the caregivers to talk about ending saying goodbye, talking to the child about their thoughts and feelings. You may plan an activity that discusses their treatment and progress. And then, importantly, APT advises us to work with the caregivers to prepare for possible regression and continued progress and recommended action. So telling parents you know, don't panic if things get worse, it doesn't mean that the treatment didn't work. I'm going to be here, you can call back if you need to, and here's what you can do to prepare.
Speaker 2:Another really hard part of our jobs as child therapists is when caregivers and legal guardians are in conflict. You want to be super clear about what your legal guidelines are. Be clear in your informed consent about what your role is going to be, especially that play therapy does not constitute a custody evaluation. Texas law is very clear about who are custody evaluators. Also, clarify that for parents. It's not uncommon for our practice to get calls for parents who really are not clear about what we can do for them in the circumstance that they're in conflict with their co-parent or the child's other caregiver co-parent or the child's other caregiver. You want to clarify your obligation not to fulfill multiple roles and that you are going to maintain confidentiality, again with the child as our primary concern for keeping their confidentiality.
Speaker 2:If there are caregivers or legal guardians with differing legal rights and responsibilities, you still need to obtain the necessary authorization and documentation to be sure that the appropriate person is obtaining treatment for this child. This is a tricky time sometimes. I've had people really get offended when I ask them for the most recent file, stamped copy of the custodial orders. Often they're in a divorce decree. They can come in other formats.
Speaker 2:I've had people try to just pull paragraphs and tell me oh, this is all you need, it's right here. When I stick to you know what the law requires me and best practices requires me to be sure that the correct person is seeking treatment. It can be hard for some folks. It also can be hard for caregivers, who are highly involved, but they may have limited legal rights, so being mindful and respectful of them. Obviously you can collaborate with them with the appropriate release of information and again, that's part of what makes our job hard as play therapists, because we are dealing with a little person in the midst of a pretty complicated system, and so APT knows that and gives us these ideas about how to navigate it in the best way that we can.
Speaker 1:And we have a question two slides ago. Sabina wants to know is one termination session enough for a child? For example, if parents decide to take the child out of therapy and their next session is the last one, is that appropriate?
Speaker 2:their next session is the last one. Is that appropriate? The short answer that comes to my mind is no. That's not really enough time. But another right answer is it depends. It depends on the child. So, ideally, what I ask parents for is a three-session termination process. So you have time to introduce the idea to the child, you have time to process it the next time and the third session you actually wrap it up. Treatment ceases as soon as you start talking about termination, so that's important to remember. If you can't get anything else, though, one is better than none. So if that's all they'll bring them back in for and I mean, how many times has that happened to y'all who see kids it's better to just be able to say goodbye, tell them that you know that that's what's up, to describe what's happening for them.
Speaker 1:We have another question about the custody. What do you do during the informed consent if one parent is not involved in the child's life but there is no conservatorship documentation?
Speaker 2:yeah. So this is where it gets into um. It's not necessarily an apt best best practices, but best practices to support you as a clinician and to support your practice. So legally, you are well within your rights to go with, for example, there might be just one custodial guardian who has rights to seek psychological treatment. You're well within your legal rights to move forward with that caregiver's consent. However, if you know that there's another parent in the child's life, my lawyer has told me best practice for me, legally and practice protection, is to get consent from both parents. I have had cases recently where there is a highly contentious situation and the divorce decree has involved the use of a like a pediatrician's recommendation as a tiebreaker. So that's where I'm not going to um. I'm not going to advise you, but it's an area of concern for those of us who see kids and I would be um. Consult with your insurance provider, your liability insurance provider. Consult with um a lawyer, if you can.
Speaker 2:Laurel Clements does a lot of great continuing education. Be really up to date on your ethical and legal responsibilities, not just to your client and their caregivers, but also to you and your practice, because when a family is in high conflict, it can get really tricky. We also talk about APT talks, about recognizing that again, as I said, that clients may have really important family members or significant adults, and to involve them when you can and with appropriate consent from their custodial guardians. To involve them when you can and with appropriate consent from their custodial guardians, really try to be transparent in treatment planning and treatment goals with those folks with appropriate consent and, I would add, with parents as well. It's not uncommon for parents really to have no idea what diagnosis their child is being treated for, to have no idea what to look for, to know if the child is getting toward their treatment goals, to not know what the therapist is recommending I mean, I've had parents report that I don't know if it's always exactly true, but really be mindful of being as transparent and informing family members with appropriate consent. And caregivers be mindful about how to honor their name and pronouns, while being aware that this can bring up really complex feelings for the family and respecting where they are with that. It's really tricky and I know that any of you that already do this you probably think about it a lot. But balancing respect for the client's right to privacy with the caregiver's legal right to be informed is one of the hardest parts of our job, in my opinion. So you really want to follow.
Speaker 2:The laws obviously include limitations to the confidentiality in informed consent. We already talked about attaining appropriate assent to treatment. They can't waive their right to privacy but they should be informed if we are going to have to divulge something. For example, I tell kids if I'm going to meet with their parents. I tell kids if I'm going to make a recommendation to their parents that it's going to be significant to them, like going to make a recommendation to their parents that is going to be significant to them Like here's what your mom wants you to sleep in your own bed. I'm going to be talking to her about that. It's part of my relationship with the child and they do deserve to know that that's coming up. If the court orders you to release confidential information, seek legal and supervisory advice. Again, your liability insurance cover may offer you this as part of your policy. Notify your insurance carrier regardless and seek to protect the client privacy as permitted by law. So obviously now you've got to divulge if you're court ordered to, but you always want to seek to minimize disclosure and also in supervision and consultation In agencies on treatment teams.
Speaker 2:I've talked to school counselors. It's so helpful to see a child in an environment where you're you know what's up, but it's also very tempting for other professionals to want to just get your ear. Hey, did you see so-and-so? And their mom dropped him off. This is what happened and it's really best practices for us to be mindful of holding that child and that caregiver's confidentiality and not engaging in that kind of information sharing unless it's very well thought out and unless you have consent to do it. With telemental health during COVID, oh my gosh we had kids in virtual sessions and it was really. It was just like the Wild West. It was so crazy and sometimes this is the only way we can get treatment to kids. So obviously best practices are to use HIPAA compliant tele-mental health platforms.
Speaker 2:Work with your clients and caregivers to set some expectations so your client can have some privacy and confidentiality.
Speaker 2:You want your own space to have client and confidentiality. I just about always have earbuds in, even if there's nobody else around, so somebody can't hear what's coming through the other side of the screen. You also best practice is to have a direct method to contact the caregiver if needed. So if you're seeing a kid and they start climbing on something. I've had them run out of the room. I've had them take the iPad to the potty, so you need a way honestly to text that caregiver like, hey, we need you in the room right now. So that's an element of working with kids in tele-mental health that we sometimes don't have to worry about. With regard to taller people, and you want to address any limits to confidentiality in the informed consent With your credentials. Obviously you only represent credentials that you've earned. Apt is very specific about how we're supposed to represent that. So, for example, as a registered play therapist supervisor, this is the way it needs to look and they've trademarked that term and so I need to use that TM and that's best practices for that.
Speaker 1:Lynn, we had one comment about asking parents to turn off security cameras if they are in the telehealth space to maintain privacy.
Speaker 2:Yeah, that's a good point. Yeah, absolutely. The other thing to think about too, just to back up to the telemental health, is thinking about if you have a child that's in a situation that has been traumatizing for them. Take that into consideration, because perhaps they have suffered something in the home and you really need to be mindful of that as you're working with them and someone else in the chat just mentioned, and I really shouldn't say the name because then like five of them will go off in my house.
Speaker 1:But Alexa, right that's true.
Speaker 2:It's true. Yeah. These are all things to think about, and I think this speaks to the rabbit hole that HIPAA feels like to me and that ethics feel like to me. It just could keep going and going, and, again, the bad news is, for somebody like me, there's no one right answer, or there's no one decision tree that's going to get me automatically to the right answer. The good news is, though, that we really have some amazing decision-making models that we can rely on. I'm going to kind of speed through these, because I'm not going to tell you you have to use one or another of them, but just knowing again that they're there and that you can follow them to arrive at a decision that you know you know is ethical and legal. So there are tons of great sources for them. Aca has a gorgeous little graphic that's a decision tree. They will guide you through what your steps are, and then you can document your following of these to show that you are ethically practicing, in general, a lot of commonalities to all these different decision-making models that are available to us.
Speaker 2:In general, you identify the problem or the dilemma, which might be harder than you might think. You want to prioritize them If there's more than one issue. You want to consider the impact on the client and your relationships, review your resources. You can consult APT best practices. What are your codes of law? Maybe a consult with a lawyer? And then you want to determine your next best step, take action and document that you have done that. This protects your license. It protects your practice. You want all of that in your charting the P3 model. The way to find it is in the resources. But basically it's been promulgated for play therapy. It's very general. I like it in that it thinks about the principles that we are adhering to as play therapists. It considers the principals. So who are the key players in this situation and what's the process that you're going to use to identify the principals, consider how the principals apply to the principals and then how you're going to apply them in dialogue and how you're going to document it. We're not going to go through how that looks because we're running out of time.
Speaker 2:One of my favorite ethical decision-making models, dr Terry Sartor and colleagues. Here it is. This is pretty amazing and here's what I love especially evaluating how the dilemma can impact the child-parent relationship, the therapist-child relationship and the parent-therapist relationship. So all of these are. It's a very helpful way to step through all of these.
Speaker 2:Finally, I encourage you to come up with an action plan. I don't know about y'all, but I have a graveyard of notes I've taken during continuing education where I've gone. That's amazing, that's a big aha, and then I get back to the office and I get busy and I never do anything with it. So a handout that I provided for y'all is to come up with an action plan. I really want you to spend just five minutes after this. Make a date with your calendar with your rules and best practices. When are you going to check them for updates? What items do you want to add to beef up your documentation? What's your preferred ethical decision-making model? You need any professional checkups, legal consultation, supervision and what ethical, legal or other continuing education do you want to do? Do a little Google search, find them. Put them on your calendar.
Speaker 1:Hey, Lynn, we've got a request for that QR code again.
Speaker 2:Oh, okay, let's see. Oh for the handouts.
Speaker 1:Yeah, and while Lynn is looking for that, jennifer posted the link one last time, so grab that link. That's the only spot you're going to be able to get the unique code as well.
Speaker 2:And, if y'all want me, I'm at learnplaytherapycom. If you have gotten one of these QR codes, you're going to be on my mailing list for upcoming trainings and I even if you don't want to come to a training, I am happy to talk to any of you.
Speaker 1:Lynn, I'm going to put that in the chat. It's learnplaytherapycom and I put Comic-Con, which doesn't help anyone. All right, check that out. Is that correct, lynn?
Speaker 2:Yeah, let me look.
Speaker 1:That's it Okay. That's it okay. So everybody take a few minutes while we're closing and open all of these links, because once the meeting closes, those links go away. Any last questions for lynn? Just lots of thanks, lynn, you're, you're, thank you so much for doing this and making it relatable and accessible, and it is. It's just so much to know and so much to remember, and I'm not a play therapist, I don't work with kids and I learned so much. So thank you for for making it accessible for me and the me's out there who are like me. So everyone, please take another second I'm talking so that you can grab those links. And please reach out to Lynn. She's got a podcast that's going to be starting soon, probably in the next couple of months. So look for that as well and get on her mailing list. She's got a lot of cool stuff happening soon. So, lynn, thank you again. Everybody, have a wonder. Oh, and there's Terry's Dr Sartor's book.
Speaker 2:Yep, and this is where the ethical decision-making model is from Dr Terry and Sartor and I always forget their first names, bill McHenry and Jim McHenry. They are the ones.
Speaker 1:Will you read the title again? I?
Speaker 2:know it's in the chat but. Ethical and Legal Issues in Counseling Children and Adolescents Cannot recommend it highly enough.
Speaker 1:Excellent, all right, everybody. Have a wonderful Thursday night, have a great Valentine's Day tomorrow or whatever you're doing on Friday. And Lynn, thank you again so much, I'll see everybody.
Speaker 2:Thank y'all.