The Colorado Counseling Association is made up of more than 1,400 members throughout the state of Colorado. We are so grateful to serve each member! 

 

The mission of the CCA is to serve its membership by promoting legislative advocacy efforts, education resources, and professional resources offered to its members.

 

 

What's in this newsletter:

Please find all of this important information below. If you have any questions, or any information to share, please email us at: info@ColoradoCounselingAssociation.org

 

Thank you from all of us here!

It is easy for veteran LPCs to forget what it is like to be a supervisee. Starting out in the counseling field can be a daunting experience that may be made worse when the supervisee does not feel allied with their supervisor. A strong working alliance is the foundation of good supervision (Bernard & Goodyear, 2019). Research shows that supervisees who have a strong working alliance believe their supervision directly contributed to positive therapeutic outcomes for their clients (Hutman et al., 2023). This alliance does not only serve the supervisee, but it benefits the supervisor as well. Supervisees who have a strong alliance with their supervisors are more likely to disclose potentially difficult situations that could impact the supervisor (Li et al., 2020). Creating a strong alliance within the supervisory relationship is an important aspect of supervision.

 

Supervisees want their supervisor to understand counseling best practices and to provide training in these practices (Li et al., 2020). Supervisors should understand more than just counseling interventions. They should also understand the laws, ethics, and administrative requirements that impact the counseling field. Supervisees feel more confident when they know that they can trust that their supervisor can train them to manage complex situations (Li et al., 2020).

 

Corrective feedback will always be a part of the supervisory relationship and it is necessary for the development of strong counselors. Corrective feedback should be affirming, appropriate and dignified (Teichman et al., 2022). Supervisees who experience acceptance alongside feedback report having better personal and professional results (Teichman et al., 2022). When supervisors engage in feedback that feels judgmental, harsh, or overly critical, supervisees can struggle to develop a positive counselor identity (Teichman et al., 2022).

 

When a supervisee is developing their counselor identity, it is important to allow them to have autonomy in their decision-making. Supervisees who are encouraged to collaborate with their supervisor on tough decisions, rather than being told what to do, report more positive treatment outcomes (Teichman et al., 2022). Providing autonomy and working with the supervisee to reach mutual conclusions about a case fosters supervisee growth and trust (Teichman et al., 2022).

 

While it is important for supervisors to respect the boundaries between supervision and therapy, it is also important for supervisors to provide a safe space for a supervisee to explore who they are in the counseling environment (Hutman et al., 2023). Self-exploration allows supervisees to recognize biases and other aspects of themselves that may negatively impact the therapeutic alliance with their clients. Supervisors can encourage greater professional growth when they provide a safe space for supervisees to engage in honest exploration (Hutman et al., 2023).

 

A strong supervisory relationship is built on trust. Understanding counseling best practices, engaging in positive corrective feedback, providing autonomy, and allowing space for supervisees to explore themselves as a counselor are all factors in creating this alliance. A supervisory relationship that is built on a foundation of trust can have a lasting impact on both the supervisee and their future clients.

 

Bernard, J. M. & Goodyear, R. K. (2019). Fundamentals of clinical supervision (6th ed.). Pearson.

Hutman, H., Ellis, M. V., Moore, J. A., Roberson, K. L., McNamara, M. L., Peterson, L. P., Taylor, E. J., & Zhou, S. (2023). Supervisees’ perspectives of inadequate, harmful, and exceptional clinical supervision: Are we listening? The Counseling Psychologist, 51(5), 719–755. https://doi.org/10.1177/00110000231172504

Li, C., Kemer, G., & Lu, J. (2022). Predictors for supervisee disclosure in supervision: A mediation model. Counselor Education and Supervision, 61(2), 193–203. https://doi.org/10.1002/ceas.12233

Teichman, Y., Berant, E., Shenkman, G., & Ramot, G. (2023). Supervisees’ perspectives on the contribution of supervision to psychotherapy outcomes. Counselling and Psychotherapy Research, 23(2), 516–529. https://doi.org/10.1002/capr.12540

Recently I read a post in an online forum in which several therapists were discussing seeing clients in public and not knowing what to do. Should they say hello? Ignore the client? One therapist even commented, “Can you say HIPAA violation?” This comment caused me to pause as seeing a client in public and even saying hello to a client is not a HIPAA violation. It’s clear many therapists don’t understand HIPAA, except to possibly fear violating HIPAA.

 

HIPAA is the Health Insurance Portability and Accountability Act and protects the privacy and security of health information and gives patients the right to their health information. Basically, HIPAA rules prevent medical professionals from disclosing protected health information (PHI), without the consent of the patient, to other providers, family members and any others, allows patients to get copies of their medical records, and requires providers to inform patients of their rights under HIPAA. It also covers electronic transfer of PHI for the provider, and business agreements with third party providers. An interesting aspect of HIPAA, according to a Center for Medicare and Medicaid Services  (CMS) fact sheet, is that HIPAA rules understand that there may accidental disclosure of PHI and that a provider can’t prevent all risks. They state this as an example: A hospital visitor may overhear a doctor’s confidential conversation with a nurse or glimpse a patient’s information on a sign-in sheet. These incidental disclosures aren’t a HIPAA violation as long as you’re following the required reasonable safeguards.

 

HIPAA safeguards change when mental health providers sense there may be harm/safety involved with the client or the safety of others. The Department of Health & Human Services (HHS) Office for Civil Rights fact sheet states, “a health or mental health professional may always share mental health information with a patient’s personal representative (if they have one) if the patient agrees, or does not object, and the information is relevant to the family member, friend, or caregiver’s involvement with the patient’s health care or the payment for such care. In addition, mental health professional may contact anyone who is reasonably able to lessen the risk of harm when they believe that a patient presents a serious and imminent threat to the health or safety of a person (including the patient) or the public. HIPAA helps professionals by ensuring that mental health information can be shared to prevent harm when the provider believes that it is necessary and the information is shared with someone who can help lessen the potential harm. For example, if a patient tells their psychotherapist that they have persistent images of harming their spouse, the psychotherapist may:  notify the spouse; call the patient’s psychiatrist or primary care doctor to review medications and develop a plan for voluntary or involuntary hospitalization or other treatment; call 911, if emergency intervention is required; and /or notify law enforcement, if needed.”

 

So how does HIPAA apply when we see a client out in public? It doesn’t directly. Nothing in HIPAA law governs seeing clients in public, unless you publicly announce that John Smith is your client and you’re seeing him for depression. Disclosing this PHI would be a violation. The issue is one of how you and your client want to acknowledge or greet each other if you see one another in public. This should be discussed in your first session and be included in your disclosure. For example, if your client has a child who attends the same school as your children or you attend the same church, discuss with the client the client’s comfort in saying hello to you as the possibility has increased that you may run into one another. Generally, I tell my clients that I may nod my head or smile in recognition, but I will not greet the client unless the client chooses to greet me, and that the client should not take my being reserved as any offense to the client. However, I am also comfortable with clients coming up to say hello if they see me in public. What I do not do, and I tell my clients this, is I will not introduce the client to any people I may be with. If clients choose to introduce themselves and any people they may be with and even disclose that I am their therapist, that’s the client’s right to do so. I do make it clear that I will not discuss with a client any issues regarding treatment as I hold all this information private and not to be discussed outside of session and in a public place.

 

Lorna Hecker, PhD, has written a great book to help mental health professionals understand HIPAA.  HIPAA Demystified: HIPAA Compliance for Mental Health Professionals. This books is a concise and comprehensive format that describes HIPA compliance in ways that are understandable and practical.

 

If you’d like more information regarding HIPPA, you can find the CMS fact sheet at https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/hipaaprivacyandsecurity.pdf)

For the HHS fact sheet https://www.hhs.gov/sites/default/files/hipaa-helps-prevent-harm.pdf)

DHHS has several fact sheets regarding HIPAA and specific situations mental health providers may incur, including opioid use. You can find them here.  https://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/index.html

PTSD has a heritability of 20-40% meaning that a significant portion of the risk of developing PTSD after a trauma is related to a person’s genes and how these are expressed. In this Research Quarterly, Dr. Matthew Girgenti provides a concise summary of the genomics related to PTSD, emphasizing how this can help better understand the biology of the disorder. This includes discussion of the work ongoing in the National Center’s PTSD Brain Bank. To read the full article, click here. https://www.ptsd.va.gov/publications/rq_docs/V35N2.pdf

College students are such a great population to work with, right? So it's important to take note of both a warning and great news that I have for those of you who work with these folks.

 

First the warning. There is a sneaky issue that may crop up and bite you in the butt when working with college students, one that can lead to a nasty insurance clawback of money.

 

Let's say your college student has their own insurance coverage, or coverage through a parent. So, you are billing the health plan, getting paid, and everything is going swimmingly.

 

Suddenly, you get a letter from the health plan that says, "this student is covered though their college health plan, which is primary." The health plan curtly asks you to repay all the money they have paid to you.

 

It turns out that this health plan that you have been billing was secondary to the client's college health plan, that you didn't even know about. Often a university's healthcare coverage is a mandatory purchase for all students, even if the student doesn’t use it. Your student may not even be aware that they have this plan, since the fee was rolled into their total school costs.

 

And it may be that you are a network provider for that university's health plan, which would require you to submit claims and calculate client copays and overpayments to you. You have to turn around and bill the university health plan for the sessions as quickly as possible, and hope they aren't denied for lack of timely filing. Suffice it to say, it's a mess.

 

So what's the good news? To my surprise, the college insurance plans I have come across even covered out-of-network therapists (including University of California, New York University, University of Texas, University of Florida, and Cornell plans). Again, students may not know they have coverage, and would be great news for those who are struggling to pay you out of pocket, if you aren't a network therapist.

 

So, what is your take away? If you are seeing a college student (of any age), it is VERY important -- before the first session -- to investigate the possibility that they have a student health plan, and determine what it covers.

 

Reprinted with permission from Barbara Griswold, LMFT. Author, Navigating the Insurance Maze: The Therapist's Complete Guide to Navigating Insurance -- And Whether You Should

408.985.0846 barbgris@aol.com (email is best)

The PTSD Research Quarterly Online (RQ) is published by the Department of Veteran Affairs (VA) and includes articles and recent research pertaining to trauma/PTSD treatment. This is a free online subscription that comes directly to your email and is just one of several publications/handouts the VA publishes. And it’s not just for therapists who see military-related trauma. The information pertains to many sources of PTSD and includes handouts, flyers, booklets, and monthly updates that you can easily download and give to your clients. Sign up for the PTSD Monthly Update or other publications from the National Center for PTSD. You can also obtain back issues of the PTSD Monthly Updates. Best of all, this information is free.

A common question we’re asked is if a therapist can see a client who is traveling out-of-state or a student whose address is in Colorado but is studying at an out-of-state college or university. The simple answer to this question is no. With the exception of active duty military members, you cannot see a client who is not physically present in Colorado. This “no” would include couples in which one party is in Colorado and the other is in another state. (We’re going to talk more about active duty military in our May newsletter – stay tuned!). If you have questions about whether another state would allow you to do this, check out that state’s licensing board rules. You can find that information here. https://www.telementalhealthtraining.com/counseling-licensing-boards

 

A second question that follows this concerns clients who are moving out-of-state and therapy will need to be transferred to a therapist in that state, but in the meantime, you are concerned about the client's mental well-being until that can be done. Can you see that client on a temporary basis? Generally the answer is no. If you know a client is moving out-of-state, you should do everything possible to ensure a smooth transition between you and your client's new therapist, to include helping the client find a therapist who can work with the client and if warranted, providing the new therapist with a clinical summary of the work you've done with the client. However, some states may have a temporary practice carve out law that may allow you to see a client on a temporary basis. Research the laws in that state or email the licensing board in that state to see if this is allowed. Make sure you get clear written approval if you have permission for doing so, you document each step you take, and you understand your malpractice insurance may not cover you for doing so. 

The Colorado Counseling Association is requesting proposals for conference sessions. The 2024 CCA Conference Lineup contains two events, both of which are currently accepting proposals through May 5th, 2024.

 

The Foundations Student Conference, uniquely for Students and Counselor Educators, will be held on August 21st, 2024, at the Keystone Resort. This event specifically targets counselors-in-training enrolled in mental health graduate programs. Event registration is restricted to students and counselor educators. However, there are no restrictions on who may submit a proposal. Proposals should directly support the training, development, and learning of counselors-in-training.

 

The Annual Conference will be held on August 22nd – 23rd, 2024, at the Keystone Resort. This two day conference is open to all mental professionals to attend and present at, and includes admittance to our keynote event, featuring Khara Croswaite Brindle as our 2024 Keynote Speaker.