Managing Your Private Practice: Establishing Professional Boundaries with Clients

Our blog series, Managing Your Private Practice, examines how to successfully run your private practice as a behavioral health clinician. Essential to any therapy practice is establishing clear, ethical boundaries with your clients, including how to set out-of-office practices, which subjects are OK to text and email a client, and how to terminate a patient-therapist relationship if need be. 

Office policies are an essential component for any successful business. When it comes to paperwork, therapists have an additional responsibility: ensuring all bases are covered in terms of legal, ethical, and HIPAA compliance. Fortunately, Health Affiliates Maine is here to help clinicians when it comes to compliance and current regulations. 

We previously addressed How to Write Office Policies, and now we’ll continue our discussion on private practices’ policy decisions as it relates to boundaries within the patient-clinician relationship. 

How a Therapist Can Take Time Away
Part of providing effective therapeutic treatment and avoiding burnout and compassion fatigue involves taking good care of yourself as a behavioral health professional. When you are ill, on vacation, or simply in need of a break, you may want to communicate your absence with clients and ensure they have continued therapeutic care if needed. 

As with other office policies, consider putting your vacation in writing. Setting clear policies in writing helps both parties know what to expect. It is also an extra step towards fulfilling an ethical obligation as a therapist to communicate in advance about plans to be away from the office. According to the ACA Code of Ethics, counselors are required to assist “in making appropriate arrangements for clients … during interruptions,” including vacations and illness. By following our suggested checklist below, you can ensure your client’s therapeutic needs are met while you recharge. 

  1. Let your clients know about your plans in advance. Give notice in both written and verbal formats, such as in an email or letter and then again in person at their session.
  2. Set up automated out-of-office messages for your voicemail and email for your time away. Include: 
    • Dates of absence and return date
    • Instructions that include how to manage emergencies or crises, such as local emergency room information or a crisis number

Likewise, if your client needs to cancel or reschedule an appointment, you may find it helpful to have standardized office policies in place to address those occasions. Here are some tips on how to write an effective missed-appointments policy 

Should You Share Clinical Information in a Text? 

While emails and text messages have become ubiquitous in our culture, questions around what type of information is professionally appropriate to share in this format arise. Behavioral health clinicians in particular have to be to be mindful of the confidentiality-related issues involved in sending information over the internet. To stay within HIPAA guidelines and the Transmission Security standard specifically, therapists often employ text or email solely for appointments and scheduling topics, leaving clinically related materials and information for in-person or other secured forms of communication. There are secure texting service providers and apps available, if you prefer to communicate through technology; however, keep in mind that licensed therapists are responsible for ensuring that the platforms are HIPAA compliant. 

An additional item to consider when texting and emailing your patients is the client record. You may need to retain and file some of the information they provide, and you will need client-informed consent regarding text messages and their documentation. If you are researching texting service providers and apps, you may want recordkeeping ability to be part of your search. 

Furthermore, when adding technology to your communication with clients, remember to be mindful of your own availability and work-life boundaries. Will introducing a new technology for communication blur the line between your time “on” and your time “off” as a therapist? This is a question you may first want to consider. 

How to Terminate a Patient-Clinician Relationship
In some instances, you may need to make the difficult decision as a therapist to terminate your professional relationship with a client. 

Can I Terminate the Client Relationship?
To avoid clients feeling abandoned and ensure your reasons for termination or referral are appropriate, consider why you are discharging the patient. 

Ideally, you will have already worked collaboratively with your client to create a care plan for their therapy. With a clear, written course of treatment, including benchmarks for goal progress, a review of the therapy plan may make it apparent that the client has either reached their goals and no longer needs assistance, or that the client needs a certain type of therapy that you may not provide.

How to Discharge a Client
If you have determined it best to discharge or refer a client, you may want to follow similar guidelines as shared below to work through the termination process in a professional manner. 

1. When you make a referral for where a client might seek treatment, give at least three options of other behavioral health providers located within a reasonable distance and who can help based on the client’s needs. This may mean making a referral to a therapist who practices with a different modality, has different training, or has more experience in a particular issue, for example. 

2. Assist your client in processing emotions related to ending the professional relationship with you. When the reason for discharge is your own career or location, consider providing as much advance notice as possible and developing a contingency plan for your clients to minimize interruptions to their therapeutic service. 

3. Finally, keep in mind that documentation throughout the patient-clinician relationship is not only required, but also a form of protection from any potential claims of abandonment by clients. Proper recordkeeping can demonstrate that you put your client’s needs first and acted ethically during each step of the process, including termination and referral. 

This Health Affiliates Maine blog post is another in our series on Managing Your Private Practice, where we explore how to successfully run your private practice as a mental health clinician. Previous articles covered how to market your private practice, create office policies, and billing and finances.

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