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HGPS Newsletter: Summer 2014

Hgps.ACTheader

HGPS NEWSLETTER SUMMER 2014 

TABLE OF CONTENTS:

Letter from the President

HGPS NEWSLETTER FEATURE 2014:

Acceptance and Commitment Therapy (ACT)

by Rachel Eddins

ACT:  What is Acceptance and Commitment Therapy?

ACT:  ACT in Group Context

Musings on Ethics…by Floyd Jennings

Cele of Approval…by Cele Keeper

Recap: 2014 HGPS Annual Institute Review…by Jean Dixon

News: Josephine Merritt Tervalon honored by Smith College School of Social Work

HGPS Members Matter….featuring news about Tenley Fukui

Caring for the Caregivers…by Cele Keeper

Letter from outgoing HGPS Editor…by Donna Nance

General Invitation for Contributions to HGPS Newsletter:  General and Special Features

The Summer 2014 Issue of the HGPS Newsletter is brought to you by:
  • Rachel Eddins, Committee Chair
  • Donna Nance, Editor
  • Cele Keeper, Author, Cele of Approval, and Caring for the Caregiver
  • Janee Bellamy
HGPS NEWSLETTER FEATURE NOTE:

For each issue, the HGPS Newsletter team surveys and reports on current treatment and therapeutic modalities being studied and used by our members in their practices. When possible, we include information on how these tools and methods might be used in Group settings.  If you would like to contribute information for future feature article of this nature, or, if you are curious about a treatment modality you may have heard of and would like for us to research and report on it in future editions of the newsletter, please contact us and let us know (contact information below).

Please be advised that treatment modalities presented in the HGPS Newsletter are for information and educational purposes only; the information presented in these articles is as diverse as HGPS members’ interests, practices and treatment philosophies. No treatment modality presented in the newsletter is specifically endorsed by HGPS.

Musings on Ethics

By Floyd L. Jennings, JD, Ph.D. 

Update on duty to report child abuse (very abbreviated)[1]:

Mental health professionals and numerous other licensed, as well as unlicensed, persons have an unequivocal duty to report suspicions of child abuse.[2]   Moreover, the standard is very low indeed, i.e. when the professional “has cause to believe has cause that an adult was a victim of abuse or neglect as a child and the person or professional determines in good faith that disclosure of the information is necessary to protect the health and safety of: (1)  another child; or  (2)  an elderly or disabled person as defined by Section 48.002, Human Resources Code.”[3]  The standard regarding children applies when the child is, or has been, or may be abused or neglected.[4]

This duty is non-delegable (you can’t direct another to make a call), and the report must be made within “48 hours” (in Texas for professionals, “immediately” for all others).[5]  And, if subpoenaed to testify, you must do so as (a) there is no privilege in criminal proceedings, generally speaking, and (b) more specifically, testimony in child abuse proceedings (which are criminal) are specifically exempt from any claim of privilege based on confidentiality that might otherwise exist in a professional relationship.[6]

What is to be reported is important.  That is, while the language varies from jurisdiction to jurisdiction, most of the statutes are similar to Texas, which states that the reportee should report: “(1) the name and address of the child; (2) the name and address of the person responsible for the care, custody, or welfare of the child; and (3) any other pertinent information concerning the alleged or suspected abuse or neglect.”[7]  The issue is that the provider must stay in his/her role and not engage in role diffusion by assuming the role of an investigator.  Further, and more specifically, the provider should avoid speculating as to the identity of the perpetrator, though may report, “The child says...”  (Or with reference to adults, “the patient says….”)

The wisest course is to report what the child says without conclusory or speculative opinion.  There is immunity for good faith reporting.  For the purpose of any civil or criminal proceeding, the good faith of the provider shall be presumed. The Board will uphold the same good faith presumption in any disciplinary proceeding that might result by reason of a licensee’s actions in participating in good faith in the making of a report, cooperating with an investigation, testifying in a proceeding arising out of an instance of suspected child abuse.  

Penalties for non-reporting begin as a Class A misdemeanor (punishable by up to 1 year  in jail and a$4000 fine), so one should err on the side of caution.

What’s new and what prompted this note is the result of the 83rd Legislature and discussed as follows:

 

Reporting abuse of now-adult patients which occurred in childhood:

In late 2011, the Texas State Board of Examiners of Psychologists requested an opinion of the Attorney General as to whether reports from adult patients of childhood abuse required reporting:  That request noted that psychologists have concerns that disclosure of the limits of confidentiality to patients would “discourage some patients from discussing important aspects of their developmental histories that may be relevant to their current symptoms and functioning.”[8]

The response of the Attorney General was quite clear; namely, that reporting of abuse relates to abuse of “a child” and if the victim is no longer “a child” then no necessity would exist for reporting.[9] 

That position remained the law until the 83rd Legislature acted to amend Tex. Fam. Code. §261.101  as follows:

(b-1)  In addition to the duty to make a report under Subsection (a) or (b), a person or professional shall make a report in the manner required by Subsection (a) or (b), as applicable, if the person or professional  has cause to believe that an adult was a victim of abuse or neglect as a child and the person or professional determines in good faith that disclosure of the information is necessary to protect the health and safety of:

(1) another child; or                                      

(2) an elderly or disabled person as defined by Section 48.002, Human Resources Code.

In practice, this means that the wiser course is to report, as psychotherapists are not investigators.  As the 2011 Attorney General opinion noted, the 48 hour reporting requirement provides little time for therapeutic discussion with the patient as regards needs to protect the health and safety of “another child” – moreover, reporting the name of the “other child” may be quite problematic.   On the other hand, there are cases when, clearly, no report should be made; e.g. when the alleged perpetrator is deceased or incapacitated (as in a nursing home).  More equivocal is the circumstance wherein the patient refuses to name the perpetrator; or when there is no known victim.  For other than the therapeutic task of enabling the patient to self-report, the psychologist would have little to say save that “I must report there has been sexual abuse in this city.  However, I cannot tell you the name of the perpetrator or name any potential victim, I can only assure you that there has been a crime committed here.”  The psychotherapist may have no information relating to the “name and address of the child” – which would also limit reporting.

        

The bottom line is that reports may well be made, in good faith, because the reportee is in no position to ascertain likely danger to a child or elderly person, and resources will be devoted to carefully entering that information, but the matter will be dropped – hopefully without opportunity for later discovery of the electronic entry in any number of circumstances. For were the report to become accessible, then the alleged perpetrator would have been painted with a brush for which there is not only no ready cleansing, but none whatsoever – as no recourse would exist to clear his/her name, was the person, in fact, innocent.

        

Nonetheless, as stated earlier, the penalty for non-reporting has been raised to a Class A misdemeanor, where the penalty may be a fine not to exceed $4000 and/or confinement not to exceed one year.

        

In short, this is not the best piece of legislation; but ours is not to create law or to disregard that which is present, but to attempt to comply in good faith.

*************



[1]           A longer version of this note can be found in the Texas Psychologist, Spring 2014, Vol 66, Issue 1, pp. 11-13.

[2]           Tex. Fam. Code §261.101

[3]           Id., amended Tex. S.B. 152, 83rd Leg. R.S. (2013)

[4]           Tex. Fam. Code §261.101(a),(b)

[5]           Tex. Fam. Code §261.101(b).

[6]           Tex. Fam. Code §261.201

[7]           Tex. Fam. Code § 261.104.

[8]           Tex. Att’y Gen. RQ No. GA-1030 (2011)

[9]           Tex. Atty’ Gen. OP No. GA-0944 (2012)

Cele of Approval: Sharing Some Thoughts on Group Work

by Cele Keeper

Let’s hear it for three tools I consider invaluable in Group Work

In my long-logged hours of supervision with new therapists in our profession, it gives me great pleasure to introduce these techniques and to see the “Aha!” look on these new faces signaling that they “get it.” And, likewise, it is to my surprise when I encounter the occasional veteran who finds her/himself stumbling across these concepts for what is apparently the first time.

I call the techniques Metaphors, Bridging-back and Scenarios.

By metaphors, I mean the use of a word or expression when a person really means something different or something more.

Hypothetical example: I’m dealing with a group and one member opens the group saying, “They had six inches of snow in Omaha last night. Wow!” There follows a series of other weather reports.

The client may mean that it was snowing in Omaha, but, unsatisfied, I pursue: I might say, “Joe, there’s a lot of snow all around the country. Will you tell us how that Omaha snow speaks to you?  Thanksgiving is two weeks away. Is there any connection for you?”

While paying close attention to body language and to facial expression, I sense that Omaha remark came from somewhere within the speaker. I try to help my students see what was said as a metaphor for something deeper. 

This client may uncover sadness at not being able to visit family, all of them mostly there in Omaha, or shame because of the strained circumstances under which he left, or any manner of other things that prompted his words. 

Maybe he used to shoot turkeys with his daddy when he was a little boy and he misses that happy time. (He knows his father is now losing his memory.)

But an opening has been created for this client to do some good work and for others in the group to begin thinking about what they will be missing or wishing for on Thanksgiving. It does, I believe, make my point.

Now a word about bridging-back…

There are so many opportunities for leaders to ask some thing like,
“You have such a satisfied smile of pleasure on your face. That’s a new face that you are letting the group see.  Will you be willing to take us back to that time where you felt that pleasure? What are you seeing? What were you doing? Were you alone? Who were you with?

As the client describes the moment or event, reach for the affect that goes with it. “What brought it today in this room? Something another member said?” 

You might suggest that the client put that memory in a toolbox when he or she needs to reach for something pleasant on a grim day.

Or, perhaps a couple comes in who are almost always angry at each other, hurling painful words, inflicting grievous wounds. 

Why have they come to see you? Believe it or not, they want to save the marriage. Alert: It is bridge-back time. 

“Well, there must have been a time when all this felt right and beautiful. Let’s go back there. To partner one: What was it you felt and saw when you first laid eyes on Joe?   Then, to the other partner, ask a similar question.

Bring the romance into the room. Talk about the ways and how it was good. “When did you know this was the person you wanted to spend your life with, make and raise a family with? 

This may be a chance to start over, find the spark and locate the things that went haywire. Rather than yelling and blaming each other, together we can set about discussing in ways that each of you can let yourself hear. This might be a way back to what you had and lost but want to find again.” 

As a therapist, I must try bridging-back. Sometimes, however, you and the couple learn it’s not worth saving. It really is move-on time.

And about scenarios…

One more thing I keep in my head is a bucket full of scenarios.

Recently, in one of my supervision groups, an intern brought up a resistance that a client had displayed in the group.  The intern wisely brought her feelings of what she felt to be ineptness on her part into supervision.

First, we need to have a look at why the client’s resistance had been so troubling for the intern. What were her feelings? Being careful about not taking on the role of her therapist, we gently see if there is anything in her own life she is experiencing when dealing with these feelings.   I further might suggest that since client resistance is an ever-present part of our work the intern might consider taking this up with her own therapist.

Now back to the client who presented the resistance: This is when I begin to speak to my group of students about scenarios: Is this client frightened? Could this feel to her like a possible replication of an old trauma?  Is she crumpling?  Sad?  Angry?  Is her body rigid?  Defiant?  Does this place have too many rules?  Does this facility feel like a prison to her? Had she served any time? 

And perhaps all-important: Whose face did she have on the person she was resisting? 

How would I suggest that my leaders help this woman?  After one leader had honored her obvious distress, they both would go to what they know about this woman’s history that will lead them to the right questions to ask.

This behavior is new to the leaders, to the group.  We know she lost a brother in Afghanistan. He had been her rock and her strength.  We know her father is a drunken deadbeat with a cruel streak. We know her mother is fragile and pill dependent for her aches and pains. The group knows some pieces of her story. Now is the time for scenarios.

With the group’s help and support, she pokes around at the answer about why she resisted so fervently what had been asked of her. The students all contributed to the discussion about how the client could have been made to feel safe while she explored such threatening territory e.g. parent, boss, teacher, pastor, someone who took control of her life and thoughts while she felt she was losing herself.

Let’s hear it for a storehouse of scenarios. On some of them, you’ll be dead wrong. Take another path.

For some of you who have been doing this since forever, this must sound simplistic. But for those of you on the new side of group therapy, I hope you will find something useful.

Ckeeper7@gmail.comg