Don't Let the Boogieman Be Your Boss

The regulating bodies for the mental health/chemical dependency field place a huge burden on the professionals in the field and that is never more apparent than when a client dies. You will lose clients. If you stay in the field for any length of time some will die. Some will die of health problems, some from violence, some will take their own lives, some will fall victim to very bad luck, and some will die of unintentional overdose. When this happens one or all of the regulation bodies will descend upon your organization and comb through your treatment notes. They may ask you uncomfortable questions, they may seem like the inquisition. You may feel unduly blamed, you may be unduly blamed and more than likely you will to some degree blame yourself. One of the worst things that can come from this is the professionals involved leave the experience thinking they can never let this happen again.

The worst policy and professional decisions are the ones motivated by fear. They usually take one of two forms, discharging a client who is deemed "too risky" to keep in your program because gods forbid they die on your watch, or putting so many unrealistic requirements on the client that they disengage or are driven away from treatment. While the death of a client under your care will require that you prove you did everything possible to keep the client alive, the death of a client shortly after discharge only requires you tried some type of intervention before the discharge. Threatening the client with discharge if they don't do A, B, and C counts as an intervention, no matter how unrealistic A, B, and C may be counts as an intervention and the regulating bodies will check that you documented the threat and leave confident you did everything you could.

So we can sleep at nigh we tell ourselves the clients brought this on themselves, that the clients failed we did not fail them. We tell ourselves we did it for the client's own good. When that fails us we resort to the Nuremberg defense, we say we didn't have a choice because if we had not discharged, if we don't continue to discharge similar clients, they will take away our licenses. The problems with this are legion so I'll just mention a few.

1) "They" the regulating bodies are not after our licenses. Not only have I never seen a counselors license revoked for continuing to treat a client who is struggling, I have never even heard of it happening. The counselors I've heard who lost their licenses (I don't know any personally) lost them for gross incompetence or unethical behavior like entering into a sexual relationship with a client. The regulating bodies need people doing our jobs so they can keep their jobs. The boogieman isn't real.

2) Even if you are answerable to a regulating body that will revoke a counselor's license for a sound clinical decision, our job is to help people to recover from substance use problems, it is not to protect our license. Usually doing the first doesn't exclude the second but to do this job right may sometimes requires a little courage.

Fear based decisions are almost never good clinical decisions if you let the boogieman be your boss you will hurt the people who need you the most.

Sent from my iPad