Show Notes

Kayla: Welcome back to the Designer Practice Podcast and I’m your host Kayla Das.

One of the real fears that many of us therapists have is receiving a complaint about our practice, whether it’s a complaint to our regulatory body or having a malpractice claim against us, knowing the steps and strategies to move forward is the first step in protecting our practices.

In today’s episode, Liane Wood, Registered Psychotherapist and owner of Psychotherapy Masterminds, will share with us helpful strategies for preventing and managing regulatory and malpractice claims before and when they arise in our private practice.

Hi, Liane. Welcome to the show. So glad to have you here today.

Liane: Thanks, Kayla. I’m really glad to be here with you.

Introduction

Kayla: It’s great to have you here. And Liane, before we dive into today’s episode, please introduce yourself, where you’re from. Tell us a little bit about your private practice journey and how you’ve gained your expertise with regulation and malpractice complaints.

Liane: Yeah. Well, being a psychotherapist is actually an encore career for me. Prior to being a psychotherapist, I’d spent over 25 years in the insurance industry as a broker. And also, during that time I was in several volunteer roles, providing peer counseling. And when I decided to go back to school to become a therapist, because I was Really enjoying the volunteer work that I was doing and I wanted to be able to transition that into a career.

And while I was working in insurance though, I spent actually a fair amount of time working in the area of professional liability with groups of highly regulated professionals, and one of my roles was to help these groups of highly regulated professionals really understand the regulations they had to work within and then to also help them come up with processes and workflows that they could use in a day in, day out basis to help them stay on side of regulations. And of course, working for an insurance company, the goal was to help them reduce the opportunities for regulatory and malpractice complaints.

And so, when I was in that role, I really learned a lot about understanding regulations and how to interpret regulations and understand them. And then also how to take that understanding and apply it into a framework of policies and workflows. And put it into a business in a way that would help to keep things on side.

Kayla: That must have been really helpful when you were starting out in your private practice knowing this information.

Liane: Well, you know, it’s really interesting because if I’m totally honest with you, that wasn’t my favorite part of my career. I did it and it was good and everything else. And so, I had actually like just pushed it off to the side. And so, when I was starting my own practice, I forgot that I had that skill set. And I felt like I was floundering in my practice after I graduated school going, “How come I can’t find a course” or it wasn’t covered in my education program, how to set up my private practice, how to do my clinical documentation. And so, I felt, for a little bit, like I was floundering and started looking for different programs or courses that I could take and then recognizing there was a shortage of it.

And then I don’t remember when or how, but at some point, the light bulb went on in my head and I went, I’ve done this before for other professionals. I should be able to do this for myself. And so that then started the journey of me really trying to put it together for my own practice.

Kayla: What’s really interesting that you say that it didn’t come first nature to you when you first started, because I think even as therapists, often we’re so great at helping other people and supporting other people. And sometimes we kind of forget about ourselves, and that really reminded me of that same thing, right? You had all this expertise, you had all of this knowledge, but you kind of forgot about it when it came to you specifically.

Liane: Exactly. It’s kind of funny when you put it that way.

Most Common Reasons a Complaint is Filed Against a Therapist

Kayla: So, from your experience, what are the most common reasons a complaint is filed against a therapist, whether it’s a regulatory complaint or a malpractice claim?

Liane: That’s a good question. There’s so many different reasons or scenarios that result in complaints or malpractice claims. If you look on some of the regulatory websites, if you like to read about, kind of discipline cases and that type of thing, you’ll see that there’s a lot of different things that come up. There’s a lot of different scenarios that result in complaints or malpractice claims.

But if you look for common underlying factors in those scenarios and claims, one thing that will show up time and again is compromise. Somewhere along the line with whatever has happened in the scenario or the situation, there’s usually a moment when the professional makes a compromise and feels that the compromise is justifiable, right? But one compromise leads to another and then another. And before you know it, a professional can be in a situation or a scenario that they never imagined they’d be in with no idea of how to fix it.

When I look at the different complaints and claims that are going on, very different scenarios and situations. But usually there’s a moment when a compromise has been made.

Kayla: Can you give us some examples of what a compromise might look like?

Liane: Well, I can try. I can try for sure. Sometimes this therapist we can have a connection with a client, right? And so, when we start to lose a little bit of our objectivity and we have that kind of special connection with a client. And that client asks us “I know your policy is X, Y, Z, but can I just this time do it this way,” or whatever and whatever it is they’re asking for and you go, “Oh, well, yeah, you know, they’re good for it whatever. It’s fine. It’s just Kayla or whoever it is, it’ll be fine.” And you make that compromise. But then what that client learns is, is that those policies and different things they don’t apply to them. And so, then the next time there’s another request and there’s another request. And so, it just becomes a very slippery slope.

I had just in conversations with different therapists, just talking about different times when there is that connection with a client and you’re thinking about “Do I relax this boundary or don’t I relax this boundary with a client?” Just take, for example, if you had a client that you’re working with and they happen to, it doesn’t matter if it’s community theater or they’re a professional actor, but they have a play going on and they’re like, “Hey, here’s tickets to my play. I’d love for you to come and see me in the play.” We usually as therapists, we don’t engage with our clients socially, right? But there may be a moment where you think, “Well, I’m just going to be in the audience, you know, whatever,” right? But then you’re invited to the after party and then the next thing happens and the next thing happens. So, because you’ve already said yes to one you can find yourself in a situation where you’re like, I would never do this with a client. And even though I have this connection with this client, I would have never said yes to this third or fourth thing, right? If I hadn’t said yes to the first one or two.

Kayla: I love that you’re connecting this and I look at it as a spectrum because compromises are things that I think that many of us, and again, coming from the very helping profession, we want to help our clients and that’s our ultimate goal. And with that, sometimes these compromises seem so innocent at first. Even if it doesn’t go to the regulatory complaint or the malpractice claim, it can still get us into quote unquote trouble.

And some of the things that were going on in my mind that I don’t know if they would come up as like a malpractice claim or a regulatory complaint. I don’t work in that field, so I don’t know. But is when you change your fees for clients, or you change your schedule for clients, and now you’re doing it for specific people maybe they’re your quote unquote favorite client. Or maybe it’s because you just want to help somebody out, but now someone else is paying your full fee and this person’s paying $20.

And with that, I mean, there’s nothing wrong with having sliding scales and that’s something that a lot of us have. But it does get us in quote unquote trouble with our own finances or our own ethics, or then we just don’t necessarily have the capacity. Maybe we’re taking on too many clients to make it up, that now we don’t have the capacity to do other things and we might forget things and all of these types of things. And I’m just looking at it as a spectrum that these compromises build up over time. And the more that we don’t stick to our own policies, the more they seem too gray for us too. So not just the client, but even us, it’s like, “Well, I did it with this client. I can do it for this one. I can do it for that one.” And then it just builds and builds and builds. So, whether it’s a regulatory complaint, a malpractice claim, or it’s sacrificing our own time and money. These compromises in the long run doesn’t help us or our business or our practice.

Liane: Well, yeah, exactly, right? And even thinking about most of the expectations or practice guidelines or standards that we have to work within, most of them have somewhere in there that we’re going to be consistent with our policies, with our clients, right? That there’s not going to be quote unquote favoritism or preferential treatment of clients. If you’re offering something to one client, the expectation would be offer it to all of your clients. And so that’s something else for us to keep in mind because we may be under the impression that they’ll never find out– the other clients will never find out that I did this for this one. And there’s no guarantees, right? There’s no guarantees that something like that wouldn’t be found out. And even just to your point, Kayla, about like, how do I keep track of all this? And in my mind if you’ve got a policy, stick with it, apply it across the board, and then you don’t have to worry about trying to remember it.

Kayla: And then once you make it a consistent thing. All your clients expect it, right? And they will trust you more and appreciate you more for it because now they’re really truly feeling equal because like you mentioned, doesn’t mean that they’re not going to find out otherwise. And sometimes people might even see each other in the waiting room and say, yeah, like, “how much do you pay for sessions?” or “what hours of day do you normally come here?” And, when we make these exceptions, it’s like, “Oh, well, I wasn’t out for that. And, I’d like to have that too.” So, it can definitely become really difficult on us. And then, of course, like the examples you had, it can start building, it can start building, and then it could become a regulatory complaint. It could become a malpractice claim. So, thank you for sharing that. It’s really some food for thought.

Liane: Mm hmm. You’re welcome.

Strategies to Protect Yourself from a Claim

Kayla: So, what can therapists do in their private practices to protect them from claims?

Liane: Yeah, well, I mean, the first one, I think obviously is you do need to have professional liability insurance in place. That’s usually a regulatory requirement of our colleges. But make sure that you have great limits in place on your policy and that the coverage is as expansive as possible for you. So, you really want to take your time and ask questions when you’re arranging that to make sure that you’ve got good limits. You can ask the person that’s arranging the coverage for you, “Are these typical policy limits? What are you seeing in terms of claims and payouts? Is this going to be enough if I had a claim?” Asking them some good questions as you’re arranging it, right? So, of course, number one, you want to make sure you’ve got a professional liability policy in place.

Another thing that you want to make sure as I’ve kind of touched on already is having really clear policies and processes in place for your practice. Being really clear about how you’re going to handle different scenarios and situations with your clients, and then sticking to them. You’re going to be tempted it’s going to happen, right? You’re going to be tempted at some point in time to make an exception for someone in a certain situation or a compromise. And I would encourage you when that happens, because it’s not if, it’s when that happens, really pause, pause, and think about why you’re considering doing this for this person. Think about what the downsides could be going forward. And also think about if you would be willing to do this for any of your other clients, right? You know, “If a similar situation came up for another one of my clients, would I be willing to do this for them as well?”

And so, one of the things that pops into my mind in terms of an exception, I have a cancellation policy, a late cancellation policy in my practice but I also have written in there because it started happening and I’m like, “Yeah, I’m not going to charge when this happens.” And it was like, if someone is really sick, they wake up in the morning and they’re really sick and they cancel the same day as their appointment. I’m not going to charge. But when that first request came in, I was like I have this late cancellation policy. They’re canceling same day. I should be charging them. And it just didn’t sit right with me because I could tell that this person was really sick. And so, I took that moment to pause, to think about it, to think about what the downsides would be. And also think, would I be willing to do this for anybody else? And the answer from me was yeah, I would do this for anybody who woke up incredibly sick on the day of their session. And so, it was easy for me to then go into my policy and write an exception.

Kayla: That’s a really good point. And, I used to run organizations before going into private practice, and it is not uncommon for any organization to update their policies, sometimes every six months, every year. I mean, every two years, but then we probably should review our policy every year. And that would be, in my opinion, best practice.

And just like you said, it doesn’t mean that you can’t update these things, right? It doesn’t mean that you can’t change them. But it’s changing them with a purpose and for the entire practice in mind versus one individual client because that person is sitting in the room asking you for whatever it is and feeling really uncomfortable about saying no to whatever that is. And if you start seeing these consistent pieces that you’re like, “You know what? This doesn’t fit with my mission. This doesn’t fit with my vision. Maybe that means I need to incorporate that into my policies.” That’s totally different because now you’re thinking of the whole practice together.

And even going back to the whole sliding scale thing I mentioned earlier. It is not uncommon for us to have sliding scales in our practices, but It’s usually best practice to have an X amount of sliding scales in your policy, that one, it protects you, but then once those slots fill up, you are being equal because you only have, say, five slots and whoever is the first to get them, gets them. So, there is still that equality piece to it. There’s still that policy piece to it as well. And then it also protects you.

Liane: Yeah. And the other thing that, I should mention in here around protecting yourself from claims is using a practice management system. That can really help you with being consistent with what you’re doing in terms of if we think about things like consent forms, when are they sent out? Many of the practice management systems, you can automate those things.

The same thing with appointment reminders. Are all of your clients getting appointment reminders or just some? If you’re using a practice management system you can automate some of that stuff. And then everybody’s getting things the day before their appointment, whatever that timing is, they’re all getting it at the same time, the same rate of frequency.

You know, I use Jane app in my practice. And one of the things, I mean, there’s many things I just talked about a couple of them. But some of the things that I really like about Jane app in terms of how it can help protect me from claims is when you get into the charting area of Jane, you can do your whole chart. Once you sign that chart, it’s locked and it’s date and time stamped, which I think is fantastic. Because I’ll tell you when you’re going into court, if those notes are ever being examined, they can look at when did the appointment happen? When did the session happen? And when was the note signed? Was it six months later? That credibility piece can come up. But you can’t within Jane app, you can’t alter the date and time that something was signed. And so, you’re able to start building credibility for yourself as a practitioner, when all of your notes are signed and timestamped.

And then, if you need to make amendments to it, the Jane system, it has a really good way of tracking the changes. That happened to a chart that are all in compliance with the regulations. And so, you don’t have to worry about those pieces. If you need to make a change, in your charts, it happens automatically. That consistency piece that we were just talking about you’re able to demonstrate that if someone questions, “Do you do this for everybody? Do you remind everybody about your cancellation and policy?” It’s like, “Yes, I do. Here it is in my system. You can see this goes out at this time to everybody because it’s in my settings.” And so, there’s ways that you can actually show and demonstrate within your practice management system, what you’re doing for everybody in your practice.

Kayla: Another piece that Jane has as well is the ability to send contracts. So, when you actually have contracts, you have proof that they had signed off on agreeing to whatever policies or whatever things that you have in your practice, so that if something then happens, you have protected yourself because they have signed it. And you have a virtual copy of that.

Most listeners know that I’m an ambassador and actually they don’t know that you’re also an ambassador for Jane and today’s episode is also sponsored by Jane. So, they would have heard a little sponsorship advertisement before they started the podcast.

But in saying that the reason we talk about it is because they have really put a lot of work into helping practitioners like us to be able to feel more confident and less overwhelmed with some of these things, like you said, the case note documentation, the client contracts, and making it so easy and almost automatic in a sense, because you could even set it up if you just want to automatically send it. I mean, I do mine manually just because I like a little bit of control over that, but you can change it that it automatically sends new clients.

Liane: Also, the billing. The billing side of things, the way that happens with receipts and all the critical components are included on the receipts. And that’s just another way that you can show regulatory compliance, but also consistency in your practice.

How to Protect Yourself When a Complaint or Claim Occurs

Kayla: I agree. So, we just talked about how we can protect ourselves from claims. But if a therapist receives a complaint or a claim against them, what are the best next steps to take?

Liane: Mm hmm. This is a really great question. And I think if we ever find ourselves in that situation, number one, the most common response is panic, right? It’s just like, “Oh my goodness. Now, what am I going to do?” And it’s also very natural to think I’m just going to fix this myself. But never, ever, ever, ever try to handle a situation if it gets to a complaint or a claim, never try to handle it on your own ever can’t emphasize that enough. If you get to the point where a complaint has been filed or a claim has been made against you, don’t even try to handle it yourself. Reach out to your professional in. Liability insurance company, let them know. That’s the first thing that you want to do.

You want to get some legal advice on how to handle it. If you are at the point where there is a complaint or a claim being filed against you, you need to get professional help to help you with navigating that. Oftentimes, when professionals try to resolve the situation on their own, they actually make the situation worse. And, that’s the last thing that any of us wants to do in a bad situation is do something to make it worse. And so, just know that if it gets to that point where there is a complaint made or there is a claim filed against you, that this is– if we want to talk about scope of practice, this is now outside your scope of practice, right? You need some other professionals to help you with navigating this and making sure that everything is being done to really reduce the chances of things getting worse.

Kayla: That’s really great advice. And something I want to highlight, and I know every province is different and every state is different, but when we think of regulatory complaints, they often come from a regulatory body, which is usually a college or a licensing board. And sometimes we think that colleges and licensing boards are there to support the therapist. But the truth is, is they are there to protect the public.

So even though we may thinking that the college or the licensing board is there to protect us. No, that’s the associations and that’s your insurance that’s there to protect you. And even then, the associations aren’t there to protect you, they’re there to support you. So, it’s really important to understand the differences because sometimes we might go into these things thinking, “Oh, well, they’re there for my best interest.” They have a mandate. They have a mission. They have a vision too. It’s not that they don’t have empathy, but they have a mission and their mission is to protect the public.

Liane: Absolutely.

Additional Insights

Kayla: So, do you have any additional advice or insights for listeners who might have overwhelming fear about getting a complaint or claim against them? And I want to be honest, one of my biggest fears starting private practice was fear of getting a complaint against me or getting sued. It was something that for a long time really paralyzed me and I’ve heard from many therapists that I’m not the only one. So how can we navigate this fear?

Liane: I think that that’s totally common, right? I think it’s very common. I don’t think there’s anyone who’s like totally comfortable with getting a complaint or a claim against them. I think there might be something wrong if that were the case. We should have a little bit of anxiety or fear or worry about, “Oh my goodness, what if this happens? How am I going to handle it? And there are things that we can do to help ourselves, right? And so, we’ve talked a little bit about this already but like doing your best ahead of time to prepare your policies and your processes in your practice, sticking with them. The more consistent you are, you really reduce the chances of having that complaint or a claim filed against you.

But then beyond those types of things, think about building a bit of a support network for yourself. Think about who would I reach out to? You’re going to reach out to your insurance company and a lawyer, but now I’m talking about the emotional side of you. Should this happen? Who would you reach out to if you ever had the possibility of a potential claim whether that’s a supervisor or an experienced colleague think of someone or a couple of someone’s that you really trust, that you can bounce things off of. So that if you have this big fear but thinking about, “Okay, I’ve got my policies and processes in place. I know I need to call my insurance company.” Maybe they’re connected with lawyer. If they’re not. Do some research. You can look online. There are lawyers that specialize in helping therapists with malpractice claims, right? So, do a Google search, do a little bit of research on them. Create a little file for yourself. Here’s my insurance. Contact information. Here’s some lawyer contact information. Here’s my policies and processes. I’m sticking to them. And should I ever think that anything is going to go sideways? I’ve also got a couple of trusted people that I can call.

You want to know what your steps are going to be should anything like this happen, right? And having a little bit of a plan like that in place can help to really reduce some of that paralyzing fear.

Kayla: I love that and something that really has helped me is reviewing my code of ethics and standards of practice because the truth is, is sometimes we think that there’s things in there that aren’t actually in there. I don’t know if it’s because every province and state is different that, we hear from this person and this person’s in a different province and they can’t do this, but I can do this and all of these types of things. So really looking at your own standards of practice and code of ethics, at least for me, had really helped me know what I can and can’t do, right? What’s black? What’s white? What’s gray?

And with that, I also want to acknowledge that fear is natural in business, especially whenever we’re feeling uncertainty. And let’s be honest, starting a private practice, growing a private practice, scaling a private practice, doing all of that stuff is all uncertain because we haven’t done it before. It’s easier to feel a bit more safer when we’re in an organization, that we feel like this sense of protection, whether it’s actual or perceived. But when we’re out on our own, the dome of protection doesn’t seem to exist. Even though I would debate that it’s probably around the same because we’re practicing the way we practice, whether we’re in an organization or a private practice. But I also think is that once we’re clear about some of the things that we can and can’t do, we also know what we are okay with and what we’re not okay with. And many of us went into private practice, become therapists because we want to help people. And we’re not going to do anything that is going to be harmful to the public intentionally, but we still need to be aware of what we can and can’t do as well.

Liane: Mm hmm. Yep. I couldn’t agree more.

Liane’s Free Resource

Kayla: So, Leanne, I know we forgot to introduce that you recently acquired a new business coaching program. Can you tell us a little bit about your new business? And I know you also have a free resource to share with listeners as well. Can you tell us a little bit about that and how it can help listeners?

Liane: Yeah, for sure, Kayla. Thanks so much. I’m so glad we remembered this before we wrap things up. Yeah, I did. I just recently acquired a company called Build Your Private Practice, and it is all about providing coaching and resources and support for Canadian mental health practitioners who are wanting to launch, grow, or scale their private practices.

So I’m very excited to have shifted from being a client in that community to now being the CEO, and it’s been an exciting journey for sure. And one of the things that I’m happy to be sharing with your community, Kayla, is a free resource that is called the Five Key Elements of Growing a Thriving Private Practice.

And so if you are in the process of working on growing your private practice, this could be very helpful and valuable to you as there’s lots of really great information inside of it.

Kayla: Fabulous. Maybe we should have you back on the podcast some day talking about how to acquire a practice because that’s so exciting. It’s such a great topic.

Liane: Oh, I would love to do that, Kayla. You let me know when and we’ll do it.

Kayla: Fabulous. To download Leanne’s free resource, Five Key Elements of Growing a Thriving Private Practice, check out kayladas.com/lianewoodfreebie.

That’s kayladas.com/lianewoodfreebie

So, Liane is spelled L. I. A. N. E.

Liane: That’s right. Yes.

Kayla: Also, you can simply scroll down to the show notes and click on the link.

Conclusion

So, Leanne, thank you so much for joining us today and giving us such great strategies and directions with respect to protecting our practices from complaints and claims. I know this has been valuable to me and I’m sure other listeners think the same.

Liane: Oh, well, thank you. Thank you, Kayla, for inviting me here and for having me on your show. This has been a lovely conversation to have with you. So, thank you.

Kayla: Thank you everyone for tuning into today’s episode and I hope you join me again soon on the Designer Practice Podcast.

Until next time, bye for now.

Credits & Disclaimers

Music by ItsWatR from Pixabay

The Designer Practice Podcast and Evaspare Inc. has an affiliate and/or sponsorship relationship for advertisements in our podcast episodes. We receive commission or monetary compensation, at no extra cost to you, when you use our promotional codes and/or check out advertisement links.