June 19, 2025 • 51 mins
Curious about the world of play therapy? Join us in an enlightening discussion where Lynn, a seasoned play therapist, reveals the ethical dimensions and best practices integral to this unique field. We kick off by exploring Lynn's journey, filled with passion for transforming children's therapy through play. As the episode unfolds, we tackle some critical topics like the ethical responsibilities of therapists, the importance of obtaining informed consent from caregivers, and how to document therapy sessions effectively.
Lynn brings her expertise to the forefront, sharing vital insights on navigating complex family dynamics and the legal guidelines governing play therapy. Every decision counts in child therapy, and Lynn emphasizes that understanding these ethical nuances is crucial for the safety and well-being of the children and their families involved.
Listeners will gain valuable strategies for balancing the needs of the child with those of parents, understanding the limits of confidentiality, and maintaining a clear focus on the best interests of the child. Whether you’re an experienced therapist or exploring the field, this episode serves as a comprehensive guide to enhancing your skills and knowledge in play therapy.
Equip yourself with resources and inspire meaningful change in your practice as you listen to Lynn's expert advice. Every child deserves the best care possible, and understand how to provide that is what this episode is all about! Don't miss out—tune in, engage with our community, and elevate your practice today!
Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:19):
Thank you, and I'm super excited about our expert
tonight and I will be reallyupset with myself if I have not
hit record.
Okay, I am recording.
Okay, good deal.
So a little housekeeping beforewe get started.
If you have not been to one ofour webinars, if you would just
take a moment and grab the chat.
(00:40):
If you click on the chat youcan actually pop it out so that
it's out there at all times andthe way we are now doing our
documentation, your CEcertificate, is.
We have broken up with emailand that means you already have
your certificate.
It's in your Kate Walkertraining profile.
You simply log in, go to thiswebinar and you can download the
(01:03):
certificate.
But you will need the uniquenumber for this webinar and the
only way you can get that is ifyou fill out the Google form.
So see, we still got you, westill got some accountability
here.
So in a few moments myassistant, jennifer Fairchild,
is going to put the Google formlink into the chat.
I highly recommend you grabthat as soon as she puts it in
(01:27):
there, click it so that the tabis open, and we all know you
keep your tabs open all day longanyway.
So one more is not going tokill you.
Keep that open and then you canfill it out later.
You don't even have to fill itout right now.
So, without further ado.
I have known Lynn for what threeyears and I have watched her
(01:48):
create things with her businessHouston Family Therapy
Associates surrounding her loveof play therapy.
Now, I'm always trying to giveher the push into doing things
like oh, I don't know, offeringcourses.
Did you just spit out yourcoffee?
I just made you laugh, didn't I?
So this is something.
I don't know how often you getto do this, lynn, but I'm so
(02:10):
excited because she's just funny.
You're going to love her and Itold her by the end of this,
y'all are going to be bestfriends.
So no pressure, lynn.
So, lynn, go ahead and unmuteand if y'all again use the chat
function to ask your questions,jennifer and I are going to
monitor the chat and we willtoss your questions to Lynn.
So, lynn, thank you so much forbeing here.
Speaker 2 (02:32):
I'm so happy to be here.
Thanks for the push and, yeah,no pressure.
Y'all, you need to love me Realquick.
Some of you, I already know, dosome play therapy, or you have
people on your staffs who doReally quick show of hands.
Who is doing play therapyalready Okay, fair number and
(02:54):
who are thinking about adding itto their practice.
Okay, a few, okay.
So we're going to be talkingabout both of those options and
I'm going to share my screenwith the slideshow.
What we're going to do, I don'tknow about y'all, but I have a
million handouts.
So about two or three slides inthere's going to be a QR code.
(03:16):
I'll pause there.
You can grab the handouts ifyou decide you want them for the
resources.
There's not going to beanything really groundbreaking
on here, but I just want to letyou know you don't have them,
because God knows how many ofthose three slides per page do
we need in our lives.
All right, so we are going to bespending an hour together
(03:40):
talking about ethics and playtherapy together, talking about
ethics and play therapy, andwhat we're going to be focusing
on is best practices as theAssociation for Play Therapy
defines them.
Why should you listen to me.
So I am a licensed clinicalsocial worker and supervisor and
(04:00):
a registered play therapistsupervisor.
Those of you who know aboutplay therapy know that the
Association for Play Therapyoffers this certification for us
.
I went to the University ofHouston Graduate College of
Social Work and I got amazingtraining and supervision there.
I was privileged to be actuallyin a small weekly play therapy
(04:25):
seminar at Texas Children's andI was inspired to start one of
my own at Small Steps NurturingCenter.
And then I decided to go on andtake the leap and I'm an APT
approved continuing educationprovider and I'm launching that
business this year with therewill be an in-person and online
(04:46):
seminar that will be next month,so y'all can tune in and
hopefully we can keep doingthose continuing education hours
for everybody working on thatRPT.
So this is going to be down anddirty and you know we're not
going to get through it all likewe're just not, because there's
so many laws, there's so manycodes of ethics, there's so many
(05:07):
best practices.
But we're going to do our bestand I'm going to save a little
time at the end for question andanswers.
So, as you have them, just jotthem down, or they're going to
be monitoring the chat too, sothey'll help me know if you have
(05:29):
them, okay.
So here is where I say if youwant to grab the slides, this
little QR code is going to getthem to you.
You'll give me your email andthen you'll get them and you'll
just have them in case you wantthem.
I think it's mainly theresources, honestly, that I want
you to be able to have.
If you need help, jennifer,kate, are monitoring the chat.
(05:52):
You know what's up to get yourcertificate, fill out your
Google form and we will belooking for whatever help you
need.
Okay, and I'm going to go on.
Hopefully everybody's grabbedthat if they need it.
Okay, here's what we're going tobe doing.
(06:12):
We're going to be identifyingethics requirements in providing
play therapy First, mostimportantly, under Texas
licensing laws, because we haveto follow the law according to
each of our licenses.
We're going to talk about bestpractices for providing play
therapy according to theAssociation for Play Therapy.
(06:32):
They're very in-depth we're notgoing to get to all of them,
which you'll thank me for that,actually and we're going to talk
about the implications ofproviding play therapy and
mental health practices andthink about some action plans
for doing that.
So, as I just mentioned, we allare bound by Texas statutes and
(06:55):
rules and they really governour licensure.
You already know that, andproviding child therapy is
pretty complicated, so not thatproviding therapy to taller
people is not, but when you havea child, there's all these
(07:16):
different kinds of things tothink about.
So we're going to be talkingabout all of that and also we're
going to be talking about theAssociation for Play Therapy and
how they give us additionalguidelines and best practices
for our use of play therapy inthe treatment room.
(07:37):
There also, as you know, arenational professional standards
and these really hold us to apretty high standard.
So, as a social worker, forexample, nasw always really
helps me out.
Now, if you're like me, I alwayshave a million tabs open on
(07:58):
Chrome and all the rules andbest practices, and so I just
put together a little desktopreference if you want it.
This is the QR code for that.
It has links to the BHEC rules,the professional codes and to
the association for play therapybest practices document, and
(08:20):
that way you're not printingthem all out or flipping from
tab to tab.
So hopefully this will behelpful to you if you want to
have them.
You already know the rules arenot identical for each
profession.
They're fairly similar.
Kate is definitely the expertin all of those kinds of BHEC
changes and you just want to besure that you're following the
(08:40):
rules for your license.
So since we're in Texas, we'regoing to talk about what our
state requirements are.
Y'all already know this.
You're ethical practitioners.
But since we're talking aboutethics, we do need to talk about
the fact that the BehavioralHealth Executive Council, as
y'all know, promulgate theserules for us.
(09:01):
They set out the requirementsthat we need to follow for our
licensure, for the ethicalpractice under those licenses,
for the protection of ourclients, and they also set out
ideas for and what we'resupposed to do for supervision,
consultation.
They also the rule books, whichare so much more convenient
(09:26):
than they used to be.
They actually offer otherrelevant sections.
So, for example, chapter 611,which governs mental health
records and talks about howwe're supposed to handle custody
matters.
They also, as a great changefrom what used to happen,
they're regularly updated andthey actually point out the
(09:47):
amendments that they've made.
So I do love that and am sograteful for BHEC about how
they're doing those things.
And then, obviously, y'all knowthe big professional
associations have their owncodes of ethics to add on to our
state licensure standards.
So ACA does this?
(10:08):
Nasw and AAMFT these reallyhold us to the highest possible
standard for our work and whenI'm in doubt, honestly, that
NASW code really holds me to agreat standard and I think that
having a strong relationshipwith those codes of ethics is a
(10:32):
strong ethical foundation.
So I alluded to this before.
Those of you who already treatkids, or those of you who are
considering it, know that thereare different ethical and legal
considerations when we'retreating children versus adults.
(10:52):
And here's where I call out oneof the attendees, dr Terry
Sartor.
This book is really one of thebest resources.
This is in the resources guidereally one of the best resources
.
This is in the resources guide.
It's called Ethical and LegalIssues in Counseling Children
and Adolescents.
It walks you through a numberof different scenarios and we
(11:15):
will talk about an ethicaldecision-making model that these
folks put together.
So it's Dr Sartor and also BillMcHenry and Jim McHenry are the
editors of this book and it isa very strong resource for us.
So, in general, things to thinkabout are that minors cannot
(11:38):
consent to treatment.
They can assent to treatment,and we'll talk about that.
So we need an authorized parentor custodial guardian to give
their legal consent.
We are required, of course, tobe sure that the authorized
custodial caregiver of thischild is giving consent to the
(11:58):
treatment, so that's covered inour licensing laws.
Another unique consideration forus as we talk about treating
kids is the issue ofconfidentiality, so we are bound
to the child client forconfidentiality and their
caregivers, which we're going totalk about everybody as
(12:20):
caregivers, whether they'reparents, custodial guardians,
all of that.
They also, though, are able toreceive some information, so we
really need to think about allof that.
We also need to governappropriate confidentiality and
therapeutic care when we arecommunicating with parents and
(12:40):
caregivers, and what are thelimits of confidentiality?
What should we know about themand who are we going to share
information with?
Kids don't exist outside of thegrownups in their lives, so if
we have an adult come in,they're able to legally give
consent, they're able to addressissues with us.
(13:02):
We may consult with someprofessionals, but for the most
part, the adult is able toself-report.
We're able to act on whatthey're doing With kids.
They can't exist, really,outside of their relationship
with the adults who are incharge of them and the
Association for Play Therapythankfully, really talks about
this and we're going to talkmore about it.
(13:23):
So just some ideas of all thedifferent key players.
When we're talking abouttreating kids, of course we have
the client, who's in the middle, and that's our focus.
We also have we add us to themix their parents and caregivers
.
Often there are co-treatingprofessionals, so there might be
(13:45):
occupational therapists, speechpathologists, teachers play a
very large part in kids' lives.
There can be non-custodialcaregivers, nannies,
grandparents, all kinds of otherthings.
There can be communityorganizations involved in
treating kids, so they might getresources from the community.
(14:08):
There may be legal implicationswith CPS or other professional
agencies and there can be pasttreating professionals that we
need to consider as we arecoordinating care and providing
the best possible care for kids.
So it can be a complicated setof players to consider, but
(14:32):
keeping the client in mind isreally so important.
So that's where we're gratefulfor, and sometimes honestly
daunted by, the Association forPlay Therapy's best practices.
In a nutshell, this is a 33-pagedocument.
(14:53):
It's been around for a while,so these best practices have
been published for more than 18years and they're reviewed
frequently five times sincetheir initial publication.
They will be reviewed againthis year.
So make a date with your APTbest practices to check out the
(15:20):
updates on what they'rerecommending.
The awareness of these playtherapy best practices are
really recommended, whether ornot you are certified as a
registered play therapist by APT.
If you're working with kids,they really recommend that you
be aware of these and they arerespectful of us in that
complicated situation I justtalked about.
It's important to know y'allare smart people and you know
(15:42):
this already.
It's important to know y'allare smart people and you know
this already.
But these are an adjunct to,not a replacement for, your
legally required practices.
So APT is not going to be incharge of your license and these
are going to be, over and above, to treat kids in the best
possible way.
According to the Association forPlay Therapy, there are many,
(16:03):
many sections.
This is a dense little document.
We are really going to focusmost for this short time
together on practice documentsand keeping strong documentation
and those kinds of similarsmall focuses.
(16:23):
But I really recommend, if youare doing plate therapy, hop in.
They cover supervision,consultation, collaboration all
kinds of great topics for us.
Okay.
So generally, if we look at BHECversus APT, bhec will offer us
(16:44):
guidelines for ethicaldocumentation.
It's important for us to payattention to these.
We're required by law toinclude them.
Not surprisingly, apt goesrecommends very specific play
(17:09):
therapy documentation.
I will tell you, I've gonethrough these several times and
every time I'm like I need toadd that to my note forms.
So that's the bad news and thegood news about this topic.
The bad news is I don't have aone size fits all solution for
you.
The bad news is I don't have aone-size-fits-all solution for
you.
The good news is that there arereally strong recommendations
(17:30):
and ethical decision-makingmodels and you have this on your
radar now, so you'll know.
Okay, I don't exactly rememberall the ins and outs, but I know
where to look to really refinemy practice, all right.
Also, bhac sets out the ethicaland legal requirements for
consent for the treatment and ofany client, but especially
(17:53):
minors, and it requirestreatment plans, as you all know
.
Apt goes more in-depth andtalks about involving caregivers
in the treatment planning, andit talks about maintaining
confidentiality for our minorclients.
Bhec also sets out prettystrong ethical and legal
requirements in technology useand APT offers more detailed
(18:16):
guidelines for the use oftechnology in play therapy,
which might sound like anoxymoron, but we do actually
sometimes are able to usetechnology and there are best
practices for doing that,especially with kids.
So, just to put this on yourradar, there are a number of
(18:38):
different sections and these arewhat I alluded to earlier.
So, to the degree that youreally want to dive in, maybe
you make a date every I don'tknow few weeks to go in and
review one of these sections andlook at ways that you could
beef up your practice with someof these ideas.
Or, if you're like you knowwhat, I am consulting with a
(18:58):
group of professionals and I'mnot really sure how to organize
this.
Maybe it's a complicated case.
You know now that there are,there's a whole section on
relationships with otherprofessionals and how to involve
them in your treatment of achild.
So I'm just putting these onhere just to just to let you
know, put them on the map foryou and you can take a look at
(19:18):
those when you have time or ifyou feel like you need to.
Okay, so APT tells us that ourcommitment and responsibilities
(19:44):
to the client primarily involveproviding treatment that
respects the dignity anduniqueness and supports the best
interest and welfare of theclient.
May include referral to adjuncttreatment of significant others
in a client's life.
Sometimes we don't reallyencounter that when we're
working with taller people, butwith kids it can be a little
more common.
I don't know how many of youchild therapists I don't know
how many times you're like, ohokay, we need to get a couples
therapist in this network.
(20:05):
So it's those kinds of thingsthat APT really addresses and
I'm always so grateful to themfor including that.
An important thing to keep inmind is that when we're treating
minors, our primaryresponsibility is to the child
and not to the caregivers, andthat's a really big deal to me
and to the child therapists thatI know.
(20:26):
And we do have responsibilityto caregivers that's not to say
we have none, but our primary isto that client, the child
client, and theirconfidentiality.
They also encourage us a PTdoes does to establish and
follow therapeutic treatmentplans that are collaborative
(20:49):
with, and understandable by, theclient and the caregivers.
So I don't know how many ofy'all think about, um, how to
cover a treatment plan with afour-year-old, how to be sure
that you're beingdevelopmentally responsive to
what their treatment goals are,and it's just something to think
(21:15):
about.
It is not always easy, but itis certainly best practices.
We want to have our treatmentgoals, treatment plans reviewed
regularly APT recommends every90 days and have a supportive
treatment plan that continues toengage the client and the
(21:37):
caregivers.
So what we tell parents in ourpractice is that 90% of the
value that their child's goingto get from treatment is going
to be based on what they dooutside of session.
So we're pretty bossy aboutmaking recommendations to
parents so that they can achievethese treatment goals, and we
really try to support parents inthat.
(21:58):
All right.
So documentation obviouslyshould include all of your legal
requirements, and, as I'm goingthrough the documentation, what
I would recommend for you is tothink about where in your
documentation this might alreadybe and where you might put it
(22:19):
in.
So maybe you just take a littlenote like oh yeah, I could add
another checkbox here or there,because I think it's a very
complicated set of documentationpractices.
Reviewing some of these listsreminds me sometimes of Dr D Ray
(22:47):
, who published AdvancedChild-Centered Play Therapy, and
there's a list of competenciesthat she encourages play
therapists to have, and the listis so comprehensive that every
time I review it, oh my gosh,how in the world am I ever going
to do all of this.
You don't have to do all of it.
The goal is always just to beworking toward mastering the
things that are important andthen maybe you tweak Again.
Every time I go through theseI'm like, oh, I could add this
(23:07):
checkbox or that to mynote-taking and I just think
it's really, it's a goal, it's aprocess, it's not an end result
.
You don't have to have done allof these already.
Okay, oops, I should havetalked.
So we want a developmentalhistory for them and this can be
(23:28):
in your intake assessment.
You want it to be very thorough, as much as you can understand
the implications of what you'reasking about and consider what
their gender pronouns are goingto be, their cultural
affiliation, obviously, thepresenting problems.
Think about the currentdevelopmental level of
functioning.
One of the key requirements ofus as play therapists is to be
(23:52):
highly aware of developmentallyappropriate behavior, because if
a four-year-old, for example,is not a highly focused, very
adept, executive, functioninghuman, that's developmentally
appropriate.
That's their job.
So part of our job the APT bestpractices really prompts us to
(24:14):
be super aware of developmentalhistory and expectations and
being an educator for caregiversabout that.
The documentation should alsoinclude the level of family
functioning and environmentalassessment includes your long
and short-term goals oftreatment and the conditions for
(24:36):
a termination assessment andtreatment review.
Most of you already know whenyou have informed consent, one
of the things to include in thatat the beginning of treatment
is how treatment will conclude,and beginning that with the
parent at the beginning is abest practice because a lot of
times it's hard for parents todiscuss, to tolerate, to plan
(24:57):
for termination of treatment.
So that's something for us tothink about and help support
caregivers in that as we goalong.
We also want to include in yourdocumentation their overall
functioning and session observedplay themes, the materials that
they use and changes.
(25:19):
Changes are a big deal.
So changes in thought process,their mood or affect their play
themes, intensity of their play,their behavior.
I'm not going to lie, I've beendoing this a long time.
Sometimes I don't know exactlywhat it means, but I know to pay
attention to it and I have aform in my note taking to pay
(25:41):
attention to overall shifts,changes.
I know when things have neverdone this before and all of that
is really important.
We also, and as play therapists,this is it's the waiting room,
it's the handoff right, it'sthat transition.
(26:01):
So clinically significantobservations of clients with
their significant others.
I know those of you who seekids.
We in the waiting room.
You see a difference if mombrings or dad brings, or nanny
or grandparents, and any of thatthat's clinically significant.
(26:22):
You want to chart that.
You also can have and shouldhave in your notes clinically
significant observations of thesignificant others when they're
seen separately from the client.
So, for example, it's notuncommon for us to meet with
(26:43):
parents and have one parent ifit's virtual, like literally on
the side of the screen, orturned completely away from the
therapist all of which isclinically significant, just
indicating the level ofinvolvement.
I've also heard parents makingcomments in the waiting area.
(27:05):
Not all of it is clinicallysignificant, but some of it is,
and so that's the part that youdefinitely want to include in
your documentation.
You also should include graphicimages that are relevant to
their behavior and goals.
So this would be examples ofsketches of sand trays or
(27:29):
photographs is very common whenthey're deemed clinically
appropriate or for a justifiedrationale, like supervision.
If you're attaining yourregistered play therapy
certification, you know you haveto have your supervisor watch a
video of a play session.
Obviously, all of that would beonly with consent from
(27:50):
caregivers, also verbal andnonverbal expressions relevant
to their behavior and theirgoals.
So all of these should be inyour documentation and just
thinking about the best way todo that, because obviously all
of it has to be HIPAA compliantconfidential.
Another really important part ofdoing play therapy seeing kids
(28:14):
is to think about touch anddocument when it's used
therapeutically and ornon-therapeutically.
And APT talks about the factthat therapeutic or non-sexual
touch can definitely havetherapeutic value, but it should
be used very mindfully, with alot of education, supervision
(28:34):
and consultation.
And again, apt gives us anothergreat resource with their paper
on touch.
If you're working with kids andyou haven't reviewed it
recently, I really recommendthat you take a look at that.
Also.
(28:55):
It comes up with kids.
We need to recognize thatclients who have been sexually
abused or inappropriatelysexualized may initiate
sexualized play or inappropriatetouching of the play therapist
and when that happens, we needto take appropriate measures to
(29:16):
help them understand that it'snot appropriate.
And definitely you need todocument this, discuss the
incident and the interventionwith the clients and or their
caregivers, engage in peerconsultation, consult your
supervisor, do whatever you needto as soon as it occurs.
It's an important part ofworking with kids in an
(29:39):
appropriate way, and it'ssomething that we all should be
aware of, and it's somethingthat we all should be aware of.
We also, obviously, shouldinclude any suicidal or
homicidal intent.
For those of you that don'twork with kids, it may be
(30:03):
surprising to hear about this inan association for play therapy
recommendation, andunfortunately it does happen,
and so I'm documenting carefullyabout the incident, the
ideation, the plan and what therecommendations and steps taken
to ensure the client's safety,and this could include referral
(30:24):
to other services, consultationwith other service providers,
hospitalization.
All of that should be in yournotes.
And again, seek consultation,seek supervision if you need it.
Speaker 1 (30:39):
And we have a question.
Okay, Question is what if oneof the parents are the abusers?
Speaker 2 (30:48):
The question is, what if one of the parents are the
abusers?
Yeah, so you're required.
We're all mandated reporters,so we're required to report to
Children's Protective Serviceswithin 48 hours of learning of
the abuse.
Ideally, the family, thecaregivers, should be involved,
(31:10):
but not if that endangers thechild.
Speaker 1 (31:14):
Does that answer the question?
It was mentioned that we needto share with caregivers.
So, sabina, do you want tounmute?
You'll be on the recording.
So if you don't want to, that'sokay, or if you want to clarify
there.
Lynn, do you know what shemeans there?
Speaker 3 (31:29):
Yeah, I would not share with caregivers if you
believe it will endanger thechild know, when you notice that
there's some initiation ofinappropriate sexual like
touching from the child, um, ifwe want to initiate first with
(31:50):
the caregivers or just hold offand just kind of wondering how
to break that down even more.
Speaker 2 (31:56):
Got it, got it, got it.
And this is a delicate situationand I think that, um, part of
what you need to think about isprotection of your own role as
an adult in a room with thechild, and that's part of the
reason why APT really recommendsletting caregivers know what
(32:16):
has happened.
But I would recommend, if youhave a lot of concerns about the
safety of the child, againconsulting, supervising and
keeping in mind that 48-hourwindow.
If you believe that somehowthat inappropriate sexualized
touching indicates or may bepart of an outcry, does that
(33:03):
make sense?
I think so.
So, just to clarify, you'resaying that if there's happening
and I will bring it up withparents in a very general way,
so this is nothing.
This is not an outcry, this isnothing that the child has told
(33:25):
me or acted out somethingdevelopmentally outside of where
they should be.
But I've talked to parents andsaid in a pretty general way so
I'm wondering about anyinappropriate touching or access
.
Who has access to this child?
Because we don't know, we don'tknow, and so sometimes just
involving them in theconversation can help in a.
(33:45):
That would be in a general way.
Again, not if there is anoutcry.
Speaker 1 (33:51):
We have a follow up in the chat.
Okay, so share with caregivers.
When a child touches thetherapist, this would also
destigmatize touch with parents.
Many jump to abuse.
Sometimes kids are touching outof exploration as well.
Is this something you discusswith parents?
Speaker 2 (34:10):
Yes, the best practices do recommend that you
discuss it, and this is whereyour knowledge of
developmentally appropriateinformation and the appropriate
development for their age comesinto play.
And I agree, for their agecomes into play and I agree, the
(34:32):
vast majority of times thathave involved touch in the
playroom have definitely notbeen inappropriate or sexualized
in nature, and it is importantto document them and you can
discuss them with parents.
But if and I don't Um, but ifand I don't, you can just
sometimes get a feeling about achild's play and that is
(34:53):
something also to pay attentionto internally, document in a way
that is helpful to you and, ifnecessary, yeah, discuss it with
the caregivers.
Okay, okay, apt also talks tous about um, including progress
(35:16):
or barriers towards goals.
Here's where I remind us allthat anything that are in your
notes should be you should bewilling to have them read out
loud in a court of law in frontof caregivers.
So you want to be sure that ifyou see parents' failure to
follow recommendations as abarrier toward a treatment goal,
(35:37):
for example probably that'snever happened to anybody who
hears this you just want to beclear about how you're
documenting that.
That protocol would be okay foryou.
You also want to documentinterventions or coordination
with significant others, andthis would be family members,
(36:00):
teachers, pediatricians,psychiatrists, and this would be
in or out of actual sessiontime.
So adjunct therapy, referrals,I mean that's.
Another part of treating kids iswe have a lot of other people
that have a lot of informationabout these little humans, and
so there's a lot of outsideconsultation time and all of
(36:23):
that should be documented.
And obviously all of that wouldonly happen with appropriate
release of information.
Also, as much as you candocument medications, medication
changes, any side effects.
Sometimes you see kids come inwith a lot of mood changes and
(36:48):
parent may report to you thatthey've just had an increase in
a medication or a reduction.
Also, you want to document anyrationale for inactions taken
with regard to complying withyour laws.
So, for example, your informedconsent form, your, your
releases of information, if youhave a telemental health consent
(37:10):
form, all of those thingsshould be in your records.
They should all be there,consent to videotape if you need
to for supervision.
And after you've done all ofthis, all of it should be
safeguarded and kept with allrequired legal guidelines, so
like HIPAA.
So you've done all these thingsand I don't, I don't know about
(37:30):
you, but again I'm like, okay,yep, I got that, no need to add
that.
So that's a lot.
So, thinking about the rights ofour clients, minors they can't
legally give consent, but APTtells us that we should work to
(37:54):
obtain assent from minor clientsto treatment.
I don't think many of usactually do this and again I
challenge you to think aboutgaining assent from a
five-year-old to treatment.
How do you developmentallyexplain to them what's going on,
(38:17):
also provide informed consentto them and their rights to
confidentiality and limits to it.
So this is again where you flexyour knowledge, your
developmental knowledge muscles,because helping a child
understand what they're agreeingto, what you're going to keep
confidential and what you're notgoing to be able to.
(38:40):
There are cases some of you maydo court appointed treatment and
really best practice is to tellthat child from the jump.
You know what.
This is not all going to besecret.
Usually what you say or whatyou play is just going to be
between you and me, unless Ithought you weren't safe.
But in the case you know you'regoing to have to turn over your
(39:04):
notes.
You can't tell him that.
So you can tell him.
You know I will be letting yourmom's lawyer know about this,
or it's really.
Kids deserve to know thosethings and it's one of the I
will say for me it's one of thehardest parts of that kind of
client, that kind of job.
(39:29):
Also, consider the therapeuticrelationship when you are
thinking about treating multipleclients.
So there are some playtherapists and I don't have I'm
not saying there's a right orwrong with any of this who
absolutely refuse to everconsider treating clients who
are in a relationship with oneanother, for example, members of
(39:51):
the same family, cousins,friends.
Really consider carefully theadvantages and disadvantages of
doing this.
All parties should be aware ofrelationships and
confidentiality and obviouslyconfidentiality should be
protected and extended toeverybody who receives the
services and not just theidentified client.
(40:12):
So in this case you wouldn'ttell you know cousin's mom
what's going on with their nieceor nephew.
You have to really be sure, ifyou are going to do this, that
you're really carefullyconsidering what it's like and
keep very tight boundaries.
(40:33):
But there are times that it isyou may feel okay about doing it
.
Obviously, I've already talkedabout termination.
It actually gives caregivershope when we talk about
termination at the beginning oftreatment, because there's this
idea that it's not going to goon forever.
(40:53):
Their kid is not always goingto have to be in therapy.
Listen, I love my job but ifI'm doing it right, I'm going to
be able to graduate your childand we're going to hopefully
talk about this plan for it andgraduate them with them in the
loop.
Obviously, you don't abandonthem, you don't neglect them.
(41:14):
If you see that treatment is noteffective or treatment goals
are just not being met, referout as you need to Involve the
children in discussion andpreparation.
I think those of us who seekids just take this like.
Of course you would do that,but it's really hard for adults
sometimes to consider theirchild saying goodbye to somebody
(41:38):
who's been important in theirlives.
So be aware that the adultsmight have some really strong
feelings about this.
Sometimes the adults makedecisions about ending treatment
for them and the child is maybenot ready, definitely not on
board.
So, collaboration with thecaregivers to talk about ending
(41:59):
saying goodbye, talking to thechild about their thoughts and
feelings.
You may plan an activity thatdiscusses their treatment and
progress.
And then, importantly, APTadvises us to work with the
caregivers to prepare forpossible regression and
continued progress andrecommended action.
So telling parents you know,don't panic if things get worse,
(42:24):
it doesn't mean that thetreatment didn't work.
I'm going to be here, you cancall back if you need to, and
here's what you can do toprepare.
Another really hard part of ourjobs as child therapists is when
caregivers and legal guardiansare in conflict.
(42:44):
You want to be super clearabout what your legal guidelines
are.
Be clear in your informedconsent about what your role is
going to be, especially thatplay therapy does not constitute
a custody evaluation.
Texas law is very clear aboutwho are custody evaluators.
Also, clarify that for parents.
(43:06):
It's not uncommon for ourpractice to get calls for
parents who really are not clearabout what we can do for them
in the circumstance that they'rein conflict with their
co-parent or the child's othercaregiver co-parent or the
child's other caregiver.
You want to clarify yourobligation not to fulfill
(43:27):
multiple roles and that you aregoing to maintain
confidentiality, again with thechild as our primary concern for
keeping their confidentiality.
If there are caregivers or legalguardians with differing legal
rights and responsibilities, youstill need to obtain the
necessary authorization anddocumentation to be sure that
(43:50):
the appropriate person isobtaining treatment for this
child.
This is a tricky time sometimes.
I've had people really getoffended when I ask them for the
most recent file, stamped copyof the custodial orders.
Often they're in a divorcedecree.
They can come in other formats.
(44:11):
I've had people try to just pullparagraphs and tell me oh, this
is all you need, it's righthere.
When I stick to you know whatthe law requires me and best
practices requires me to be surethat the correct person is
seeking treatment.
It can be hard for some folks.
(44:32):
It also can be hard forcaregivers, who are highly
involved, but they may havelimited legal rights, so being
mindful and respectful of them.
Obviously you can collaboratewith them with the appropriate
release of information and again, that's part of what makes our
job hard as play therapists,because we are dealing with a
(44:55):
little person in the midst of apretty complicated system, and
so APT knows that and gives usthese ideas about how to
navigate it in the best way thatwe can.
Speaker 1 (45:07):
And we have a question two slides ago.
Sabina wants to know is onetermination session enough for a
child?
For example, if parents decideto take the child out of therapy
and their next session is thelast one, is that appropriate?
Speaker 2 (45:29):
their next session is the last one.
Is that appropriate?
The short answer that comes tomy mind is no.
That's not really enough time.
But another right answer is itdepends.
It depends on the child.
So, ideally, what I ask parentsfor is a three-session
termination process.
So you have time to introducethe idea to the child, you have
(45:49):
time to process it the next timeand the third session you
actually wrap it up.
Treatment ceases as soon as youstart talking about termination
, so that's important toremember.
If you can't get anything else,though, one is better than none
.
So if that's all they'll bringthem back in for and I mean, how
(46:09):
many times has that happened toy'all who see kids it's better
to just be able to say goodbye,tell them that you know that
that's what's up, to describewhat's happening for them.
Speaker 1 (46:23):
We have another question about the custody.
What do you do during theinformed consent if one parent
is not involved in the child'slife but there is no
conservatorship documentation?
Speaker 2 (46:38):
yeah.
So this is where it gets intoum.
It's not necessarily an aptbest best practices, but best
practices to support you as aclinician and to support your
practice.
So legally, you are well withinyour rights to go with, for
example, there might be just onecustodial guardian who has
(47:00):
rights to seek psychologicaltreatment.
You're well within your legalrights to move forward with that
caregiver's consent.
However, if you know thatthere's another parent in the
child's life, my lawyer has toldme best practice for me,
legally and practice protection,is to get consent from both
(47:22):
parents.
I have had cases recently wherethere is a highly contentious
situation and the divorce decreehas involved the use of a like
a pediatrician's recommendationas a tiebreaker.
So that's where I'm not goingto um.
(47:43):
I'm not going to advise you,but it's an area of concern for
those of us who see kids and Iwould be um.
Consult with your insuranceprovider, your liability
insurance provider.
Consult with um a lawyer, ifyou can.
Laurel Clements does a lot ofgreat continuing education.
(48:05):
Be really up to date on yourethical and legal
responsibilities, not just toyour client and their caregivers
, but also to you and yourpractice, because when a family
is in high conflict, it can getreally tricky.
We also talk about APT talks,about recognizing that again, as
(48:37):
I said, that clients may havereally important family members
or significant adults, and toinvolve them when you can and
with appropriate consent fromtheir custodial guardians.
To involve them when you canand with appropriate consent
from their custodial guardians,really try to be transparent in
treatment planning and treatmentgoals with those folks with
appropriate consent and, I wouldadd, with parents as well.
(48:59):
It's not uncommon for parentsreally to have no idea what
diagnosis their child is beingtreated for, to have no idea
what to look for, to know if thechild is getting toward their
treatment goals, to not knowwhat the therapist is
recommending I mean, I've hadparents report that I don't know
if it's always exactly true,but really be mindful of being
as transparent and informingfamily members with appropriate
(49:23):
consent.
And caregivers be mindful abouthow to honor their name and
(49:45):
pronouns, while being aware thatthis can bring up really
complex feelings for the familyand respecting where they are
with that.
It's really tricky and I knowthat any of you that already do
this you probably think about ita lot.
But balancing respect for theclient's right to privacy with
(50:06):
the caregiver's legal right tobe informed is one of the
hardest parts of our job, in myopinion.
So you really want to follow.
The laws obviously includelimitations to the
confidentiality in informedconsent.
We already talked aboutattaining appropriate assent to
treatment.
They can't waive their right toprivacy but they should be
(50:28):
informed if we are going to haveto divulge something.
For example, I tell kids if I'mgoing to meet with their
parents.
I tell kids if I'm going tomake a recommendation to their
parents that it's going to besignificant to them, like going
to make a recommendation totheir parents that is going to
be significant to them Likehere's what your mom wants you
to sleep in your own bed.
I'm going to be talking to herabout that.
(50:50):
It's part of my relationshipwith the child and they do
deserve to know that that'scoming up.
If the court orders you torelease confidential information
, seek legal and supervisoryadvice.
Again, your liability insurancecover may offer you this as
(51:11):
part of your policy.
Notify your insurance carrierregardless and seek to protect
the client privacy as permittedby law.
So obviously now you've got todivulge if you're court ordered
to, but you always want to seekto minimize disclosure and also
in supervision and consultationIn agencies on treatment teams.
(51:34):
I've talked to school counselors.
It's so helpful to see a childin an environment where you're
you know what's up, but it'salso very tempting for other
professionals to want to justget your ear.
Hey, did you see so-and-so?
And their mom dropped him off.
This is what happened and it'sreally best practices for us to
(51:54):
be mindful of holding that childand that caregiver's
confidentiality and not engagingin that kind of information
sharing unless it's very wellthought out and unless you have
consent to do it.
With telemental health duringCOVID, oh my gosh we had kids in
(52:18):
virtual sessions and it wasreally.
It was just like the Wild West.
It was so crazy and sometimesthis is the only way we can get
treatment to kids.
So obviously best practices areto use HIPAA compliant
tele-mental health platforms.
Work with your clients andcaregivers to set some
(52:39):
expectations so your client canhave some privacy and
confidentiality.
You want your own space to haveclient and confidentiality.
I just about always haveearbuds in, even if there's
nobody else around, so somebodycan't hear what's coming through
the other side of the screen.
(52:59):
You also best practice is tohave a direct method to contact
the caregiver if needed.
So if you're seeing a kid andthey start climbing on something
.
I've had them run out of theroom.
I've had them take the iPad tothe potty, so you need a way
honestly to text that caregiverlike, hey, we need you in the
(53:19):
room right now.
So that's an element of workingwith kids in tele-mental health
that we sometimes don't have toworry about.
With regard to taller people,and you want to address any
limits to confidentiality in theinformed consent With your
credentials.
Obviously you only representcredentials that you've earned.
(53:40):
Apt is very specific about howwe're supposed to represent that
.
So, for example, as aregistered play therapist
supervisor, this is the way itneeds to look and they've
trademarked that term and so Ineed to use that TM and that's
best practices for that.
Speaker 1 (53:57):
Lynn, we had one comment about asking parents to
turn off security cameras ifthey are in the telehealth space
to maintain privacy.
Speaker 2 (54:05):
Yeah, that's a good point.
Yeah, absolutely.
The other thing to think abouttoo, just to back up to the
telemental health, is thinkingabout if you have a child that's
in a situation that has beentraumatizing for them.
Take that into consideration,because perhaps they have
suffered something in the homeand you really need to be
(54:26):
mindful of that as you'reworking with them and someone
else in the chat just mentioned,and I really shouldn't say the
name because then like five ofthem will go off in my house.
Speaker 1 (54:36):
But Alexa, right that's true.
Speaker 2 (54:41):
It's true.
Yeah.
These are all things to thinkabout, and I think this speaks
to the rabbit hole that HIPAAfeels like to me and that ethics
feel like to me.
It just could keep going andgoing, and, again, the bad news
is, for somebody like me,there's no one right answer, or
there's no one decision treethat's going to get me
(55:03):
automatically to the rightanswer.
The good news is, though, thatwe really have some amazing
decision-making models that wecan rely on.
I'm going to kind of speedthrough these, because I'm not
going to tell you you have touse one or another of them, but
just knowing again that they'rethere and that you can follow
them to arrive at a decisionthat you know you know is
(55:25):
ethical and legal.
So there are tons of greatsources for them.
Aca has a gorgeous littlegraphic that's a decision tree.
They will guide you throughwhat your steps are, and then
you can document your followingof these to show that you are
ethically practicing, in general, a lot of commonalities to all
(55:51):
these different decision-makingmodels that are available to us.
In general, you identify theproblem or the dilemma, which
might be harder than you mightthink.
You want to prioritize them Ifthere's more than one issue.
You want to consider the impacton the client and your
relationships, review yourresources.
You can consult APT bestpractices.
(56:11):
What are your codes of law?
Maybe a consult with a lawyer?
And then you want to determineyour next best step, take action
and document that you have donethat.
This protects your license.
It protects your practice.
You want all of that in yourcharting the P3 model.
The way to find it is in theresources.
But basically it's beenpromulgated for play therapy.
(56:35):
It's very general.
I like it in that it thinksabout the principles that we are
adhering to as play therapists.
It considers the principals.
So who are the key players inthis situation and what's the
process that you're going to useto identify the principals,
(56:56):
consider how the principalsapply to the principals and then
how you're going to apply themin dialogue and how you're going
to document it.
We're not going to go throughhow that looks because we're
running out of time.
One of my favorite ethicaldecision-making models, dr Terry
Sartor and colleagues.
Here it is.
This is pretty amazing andhere's what I love especially
(57:19):
evaluating how the dilemma canimpact the child-parent
relationship, thetherapist-child relationship and
the parent-therapistrelationship.
So all of these are.
It's a very helpful way to stepthrough all of these.
Finally, I encourage you to comeup with an action plan.
(57:39):
I don't know about y'all, but Ihave a graveyard of notes I've
taken during continuingeducation where I've gone.
That's amazing, that's a bigaha, and then I get back to the
office and I get busy and Inever do anything with it.
So a handout that I providedfor y'all is to come up with an
action plan.
I really want you to spend justfive minutes after this.
(58:00):
Make a date with your calendarwith your rules and best
practices.
When are you going to checkthem for updates?
What items do you want to addto beef up your documentation?
What's your preferred ethicaldecision-making model?
You need any professionalcheckups, legal consultation,
supervision and what ethical,legal or other continuing
(58:23):
education do you want to do?
Do a little Google search, findthem.
Put them on your calendar.
Speaker 1 (58:28):
Hey, Lynn, we've got a request for that QR code again
.
Speaker 2 (58:31):
Oh, okay, let's see.
Oh for the handouts.
Speaker 1 (58:36):
Yeah, and while Lynn is looking for that, jennifer
posted the link one last time,so grab that link.
That's the only spot you'regoing to be able to get the
unique code as well.
Speaker 2 (58:46):
And, if y'all want me , I'm at learnplaytherapycom.
If you have gotten one of theseQR codes, you're going to be on
my mailing list for upcomingtrainings and I even if you
don't want to come to a training, I am happy to talk to any of
you.
Speaker 1 (59:01):
Lynn, I'm going to put that in the chat.
It's learnplaytherapycom and Iput Comic-Con, which doesn't
help anyone.
All right, check that out.
Is that correct, lynn?
Speaker 2 (59:16):
Yeah, let me look.
Speaker 1 (59:22):
That's it Okay.
That's it okay.
So everybody take a few minuteswhile we're closing and open
all of these links, because oncethe meeting closes, those links
go away.
Any last questions for lynn?
Just lots of thanks, lynn,you're, you're, thank you so
(59:43):
much for doing this and makingit relatable and accessible, and
it is.
It's just so much to know andso much to remember, and I'm not
a play therapist, I don't workwith kids and I learned so much.
So thank you for for making itaccessible for me and the me's
out there who are like me.
So everyone, please takeanother second I'm talking so
(01:00:09):
that you can grab those links.
And please reach out to Lynn.
She's got a podcast that'sgoing to be starting soon,
probably in the next couple ofmonths.
So look for that as well andget on her mailing list.
She's got a lot of cool stuffhappening soon.
So, lynn, thank you again.
Everybody, have a wonder.
Oh, and there's Terry's DrSartor's book.
Speaker 2 (01:00:31):
Yep, and this is where the ethical
decision-making model is from DrTerry and Sartor and I always
forget their first names, billMcHenry and Jim McHenry.
They are the ones.
Speaker 1 (01:00:42):
Will you read the title again?
I?
Speaker 2 (01:00:43):
know it's in the chat but.
Ethical and Legal Issues inCounseling Children and
Adolescents Cannot recommend ithighly enough.
Speaker 1 (01:00:51):
Excellent, all right, everybody.
Have a wonderful Thursday night, have a great Valentine's Day
tomorrow or whatever you'redoing on Friday.
And Lynn, thank you again somuch, I'll see everybody.
Speaker 2 (01:01:02):
Thank y'all.
Thank you, and I'm super excited about our expert
tonight and I will be reallyupset with myself if I have not
hit record.
Okay, I am recording.
Okay, good deal.
So a little housekeeping beforewe get started.
If you have not been to one ofour webinars, if you would just
take a moment and grab the chat.
(00:40):
If you click on the chat youcan actually pop it out so that
it's out there at all times andthe way we are now doing our
documentation, your CEcertificate, is.
We have broken up with emailand that means you already have
your certificate.
It's in your Kate Walkertraining profile.
You simply log in, go to thiswebinar and you can download the
(01:03):
certificate.
But you will need the uniquenumber for this webinar and the
only way you can get that is ifyou fill out the Google form.
So see, we still got you, westill got some accountability
here.
So in a few moments myassistant, jennifer Fairchild,
is going to put the Google formlink into the chat.
I highly recommend you grabthat as soon as she puts it in
(01:27):
there, click it so that the tabis open, and we all know you
keep your tabs open all day longanyway.
So one more is not going tokill you.
Keep that open and then you canfill it out later.
You don't even have to fill itout right now.
So, without further ado.
I have known Lynn for what threeyears and I have watched her
(01:48):
create things with her businessHouston Family Therapy
Associates surrounding her loveof play therapy.
Now, I'm always trying to giveher the push into doing things
like oh, I don't know, offeringcourses.
Did you just spit out yourcoffee?
I just made you laugh, didn't I?
So this is something.
I don't know how often you getto do this, lynn, but I'm so
(02:10):
excited because she's just funny.
You're going to love her and Itold her by the end of this,
y'all are going to be bestfriends.
So no pressure, lynn.
So, lynn, go ahead and unmuteand if y'all again use the chat
function to ask your questions,jennifer and I are going to
monitor the chat and we willtoss your questions to Lynn.
So, lynn, thank you so much forbeing here.
Speaker 2 (02:32):
I'm so happy to be here.
Thanks for the push and, yeah,no pressure.
Y'all, you need to love me Realquick.
Some of you, I already know, dosome play therapy, or you have
people on your staffs who doReally quick show of hands.
Who is doing play therapyalready Okay, fair number and
(02:54):
who are thinking about adding itto their practice.
Okay, a few, okay.
So we're going to be talkingabout both of those options and
I'm going to share my screenwith the slideshow.
What we're going to do, I don'tknow about y'all, but I have a
million handouts.
So about two or three slides inthere's going to be a QR code.
(03:16):
I'll pause there.
You can grab the handouts ifyou decide you want them for the
resources.
There's not going to beanything really groundbreaking
on here, but I just want to letyou know you don't have them,
because God knows how many ofthose three slides per page do
we need in our lives.
All right, so we are going to bespending an hour together
(03:40):
talking about ethics and playtherapy together, talking about
ethics and play therapy, andwhat we're going to be focusing
on is best practices as theAssociation for Play Therapy
defines them.
Why should you listen to me.
So I am a licensed clinicalsocial worker and supervisor and
(04:00):
a registered play therapistsupervisor.
Those of you who know aboutplay therapy know that the
Association for Play Therapyoffers this certification for us
.
I went to the University ofHouston Graduate College of
Social Work and I got amazingtraining and supervision there.
I was privileged to be actuallyin a small weekly play therapy
(04:25):
seminar at Texas Children's andI was inspired to start one of
my own at Small Steps NurturingCenter.
And then I decided to go on andtake the leap and I'm an APT
approved continuing educationprovider and I'm launching that
business this year with therewill be an in-person and online
(04:46):
seminar that will be next month,so y'all can tune in and
hopefully we can keep doingthose continuing education hours
for everybody working on thatRPT.
So this is going to be down anddirty and you know we're not
going to get through it all likewe're just not, because there's
so many laws, there's so manycodes of ethics, there's so many
(05:07):
best practices.
But we're going to do our bestand I'm going to save a little
time at the end for question andanswers.
So, as you have them, just jotthem down, or they're going to
be monitoring the chat too, sothey'll help me know if you have
(05:29):
them, okay.
So here is where I say if youwant to grab the slides, this
little QR code is going to getthem to you.
You'll give me your email andthen you'll get them and you'll
just have them in case you wantthem.
I think it's mainly theresources, honestly, that I want
you to be able to have.
If you need help, jennifer,kate, are monitoring the chat.
(05:52):
You know what's up to get yourcertificate, fill out your
Google form and we will belooking for whatever help you
need.
Okay, and I'm going to go on.
Hopefully everybody's grabbedthat if they need it.
Okay, here's what we're going tobe doing.
(06:12):
We're going to be identifyingethics requirements in providing
play therapy First, mostimportantly, under Texas
licensing laws, because we haveto follow the law according to
each of our licenses.
We're going to talk about bestpractices for providing play
therapy according to theAssociation for Play Therapy.
(06:32):
They're very in-depth we're notgoing to get to all of them,
which you'll thank me for that,actually and we're going to talk
about the implications ofproviding play therapy and
mental health practices andthink about some action plans
for doing that.
So, as I just mentioned, we allare bound by Texas statutes and
(06:55):
rules and they really governour licensure.
You already know that, andproviding child therapy is
pretty complicated, so not thatproviding therapy to taller
people is not, but when you havea child, there's all these
(07:16):
different kinds of things tothink about.
So we're going to be talkingabout all of that and also we're
going to be talking about theAssociation for Play Therapy and
how they give us additionalguidelines and best practices
for our use of play therapy inthe treatment room.
(07:37):
There also, as you know, arenational professional standards
and these really hold us to apretty high standard.
So, as a social worker, forexample, nasw always really
helps me out.
Now, if you're like me, I alwayshave a million tabs open on
(07:58):
Chrome and all the rules andbest practices, and so I just
put together a little desktopreference if you want it.
This is the QR code for that.
It has links to the BHEC rules,the professional codes and to
the association for play therapybest practices document, and
(08:20):
that way you're not printingthem all out or flipping from
tab to tab.
So hopefully this will behelpful to you if you want to
have them.
You already know the rules arenot identical for each
profession.
They're fairly similar.
Kate is definitely the expertin all of those kinds of BHEC
changes and you just want to besure that you're following the
(08:40):
rules for your license.
So since we're in Texas, we'regoing to talk about what our
state requirements are.
Y'all already know this.
You're ethical practitioners.
But since we're talking aboutethics, we do need to talk about
the fact that the BehavioralHealth Executive Council, as
y'all know, promulgate theserules for us.
(09:01):
They set out the requirementsthat we need to follow for our
licensure, for the ethicalpractice under those licenses,
for the protection of ourclients, and they also set out
ideas for and what we'resupposed to do for supervision,
consultation.
They also the rule books, whichare so much more convenient
(09:26):
than they used to be.
They actually offer otherrelevant sections.
So, for example, chapter 611,which governs mental health
records and talks about howwe're supposed to handle custody
matters.
They also, as a great changefrom what used to happen,
they're regularly updated andthey actually point out the
(09:47):
amendments that they've made.
So I do love that and am sograteful for BHEC about how
they're doing those things.
And then, obviously, y'all knowthe big professional
associations have their owncodes of ethics to add on to our
state licensure standards.
So ACA does this?
(10:08):
Nasw and AAMFT these reallyhold us to the highest possible
standard for our work and whenI'm in doubt, honestly, that
NASW code really holds me to agreat standard and I think that
having a strong relationshipwith those codes of ethics is a
(10:32):
strong ethical foundation.
So I alluded to this before.
Those of you who already treatkids, or those of you who are
considering it, know that thereare different ethical and legal
considerations when we'retreating children versus adults.
(10:52):
And here's where I call out oneof the attendees, dr Terry
Sartor.
This book is really one of thebest resources.
This is in the resources guidereally one of the best resources
.
This is in the resources guide.
It's called Ethical and LegalIssues in Counseling Children
and Adolescents.
It walks you through a numberof different scenarios and we
(11:15):
will talk about an ethicaldecision-making model that these
folks put together.
So it's Dr Sartor and also BillMcHenry and Jim McHenry are the
editors of this book and it isa very strong resource for us.
So, in general, things to thinkabout are that minors cannot
(11:38):
consent to treatment.
They can assent to treatment,and we'll talk about that.
So we need an authorized parentor custodial guardian to give
their legal consent.
We are required, of course, tobe sure that the authorized
custodial caregiver of thischild is giving consent to the
(11:58):
treatment, so that's covered inour licensing laws.
Another unique consideration forus as we talk about treating
kids is the issue ofconfidentiality, so we are bound
to the child client forconfidentiality and their
caregivers, which we're going totalk about everybody as
(12:20):
caregivers, whether they'reparents, custodial guardians,
all of that.
They also, though, are able toreceive some information, so we
really need to think about allof that.
We also need to governappropriate confidentiality and
therapeutic care when we arecommunicating with parents and
(12:40):
caregivers, and what are thelimits of confidentiality?
What should we know about themand who are we going to share
information with?
Kids don't exist outside of thegrownups in their lives, so if
we have an adult come in,they're able to legally give
consent, they're able to addressissues with us.
(13:02):
We may consult with someprofessionals, but for the most
part, the adult is able toself-report.
We're able to act on whatthey're doing With kids.
They can't exist, really,outside of their relationship
with the adults who are incharge of them and the
Association for Play Therapythankfully, really talks about
this and we're going to talkmore about it.
(13:23):
So just some ideas of all thedifferent key players.
When we're talking abouttreating kids, of course we have
the client, who's in the middle, and that's our focus.
We also have we add us to themix their parents and caregivers
.
Often there are co-treatingprofessionals, so there might be
(13:45):
occupational therapists, speechpathologists, teachers play a
very large part in kids' lives.
There can be non-custodialcaregivers, nannies,
grandparents, all kinds of otherthings.
There can be communityorganizations involved in
treating kids, so they might getresources from the community.
(14:08):
There may be legal implicationswith CPS or other professional
agencies and there can be pasttreating professionals that we
need to consider as we arecoordinating care and providing
the best possible care for kids.
So it can be a complicated setof players to consider, but
(14:32):
keeping the client in mind isreally so important.
So that's where we're gratefulfor, and sometimes honestly
daunted by, the Association forPlay Therapy's best practices.
In a nutshell, this is a 33-pagedocument.
(14:53):
It's been around for a while,so these best practices have
been published for more than 18years and they're reviewed
frequently five times sincetheir initial publication.
They will be reviewed againthis year.
So make a date with your APTbest practices to check out the
(15:20):
updates on what they'rerecommending.
The awareness of these playtherapy best practices are
really recommended, whether ornot you are certified as a
registered play therapist by APT.
If you're working with kids,they really recommend that you
be aware of these and they arerespectful of us in that
complicated situation I justtalked about.
It's important to know y'allare smart people and you know
(15:42):
this already.
It's important to know y'allare smart people and you know
this already.
But these are an adjunct to,not a replacement for, your
legally required practices.
So APT is not going to be incharge of your license and these
are going to be, over and above, to treat kids in the best
possible way.
According to the Association forPlay Therapy, there are many,
(16:03):
many sections.
This is a dense little document.
We are really going to focusmost for this short time
together on practice documentsand keeping strong documentation
and those kinds of similarsmall focuses.
(16:23):
But I really recommend, if youare doing plate therapy, hop in.
They cover supervision,consultation, collaboration all
kinds of great topics for us.
Okay.
So generally, if we look at BHECversus APT, bhec will offer us
(16:44):
guidelines for ethicaldocumentation.
It's important for us to payattention to these.
We're required by law toinclude them.
Not surprisingly, apt goesrecommends very specific play
(17:09):
therapy documentation.
I will tell you, I've gonethrough these several times and
every time I'm like I need toadd that to my note forms.
So that's the bad news and thegood news about this topic.
The bad news is I don't have aone size fits all solution for
you.
The bad news is I don't have aone-size-fits-all solution for
you.
The good news is that there arereally strong recommendations
(17:30):
and ethical decision-makingmodels and you have this on your
radar now, so you'll know.
Okay, I don't exactly rememberall the ins and outs, but I know
where to look to really refinemy practice, all right.
Also, bhac sets out the ethicaland legal requirements for
consent for the treatment and ofany client, but especially
(17:53):
minors, and it requirestreatment plans, as you all know
.
Apt goes more in-depth andtalks about involving caregivers
in the treatment planning, andit talks about maintaining
confidentiality for our minorclients.
Bhec also sets out prettystrong ethical and legal
requirements in technology useand APT offers more detailed
(18:16):
guidelines for the use oftechnology in play therapy,
which might sound like anoxymoron, but we do actually
sometimes are able to usetechnology and there are best
practices for doing that,especially with kids.
So, just to put this on yourradar, there are a number of
(18:38):
different sections and these arewhat I alluded to earlier.
So, to the degree that youreally want to dive in, maybe
you make a date every I don'tknow few weeks to go in and
review one of these sections andlook at ways that you could
beef up your practice with someof these ideas.
Or, if you're like you knowwhat, I am consulting with a
(18:58):
group of professionals and I'mnot really sure how to organize
this.
Maybe it's a complicated case.
You know now that there are,there's a whole section on
relationships with otherprofessionals and how to involve
them in your treatment of achild.
So I'm just putting these onhere just to just to let you
know, put them on the map foryou and you can take a look at
(19:18):
those when you have time or ifyou feel like you need to.
Okay, so APT tells us that ourcommitment and responsibilities
(19:44):
to the client primarily involveproviding treatment that
respects the dignity anduniqueness and supports the best
interest and welfare of theclient.
May include referral to adjuncttreatment of significant others
in a client's life.
Sometimes we don't reallyencounter that when we're
working with taller people, butwith kids it can be a little
more common.
I don't know how many of youchild therapists I don't know
how many times you're like, ohokay, we need to get a couples
therapist in this network.
(20:05):
So it's those kinds of thingsthat APT really addresses and
I'm always so grateful to themfor including that.
An important thing to keep inmind is that when we're treating
minors, our primaryresponsibility is to the child
and not to the caregivers, andthat's a really big deal to me
and to the child therapists thatI know.
(20:26):
And we do have responsibilityto caregivers that's not to say
we have none, but our primary isto that client, the child
client, and theirconfidentiality.
They also encourage us a PTdoes does to establish and
follow therapeutic treatmentplans that are collaborative
(20:49):
with, and understandable by, theclient and the caregivers.
So I don't know how many ofy'all think about, um, how to
cover a treatment plan with afour-year-old, how to be sure
that you're beingdevelopmentally responsive to
what their treatment goals are,and it's just something to think
(21:15):
about.
It is not always easy, but itis certainly best practices.
We want to have our treatmentgoals, treatment plans reviewed
regularly APT recommends every90 days and have a supportive
treatment plan that continues toengage the client and the
(21:37):
caregivers.
So what we tell parents in ourpractice is that 90% of the
value that their child's goingto get from treatment is going
to be based on what they dooutside of session.
So we're pretty bossy aboutmaking recommendations to
parents so that they can achievethese treatment goals, and we
really try to support parents inthat.
(21:58):
All right.
So documentation obviouslyshould include all of your legal
requirements, and, as I'm goingthrough the documentation, what
I would recommend for you is tothink about where in your
documentation this might alreadybe and where you might put it
(22:19):
in.
So maybe you just take a littlenote like oh yeah, I could add
another checkbox here or there,because I think it's a very
complicated set of documentationpractices.
Reviewing some of these listsreminds me sometimes of Dr D Ray
(22:47):
, who published AdvancedChild-Centered Play Therapy, and
there's a list of competenciesthat she encourages play
therapists to have, and the listis so comprehensive that every
time I review it, oh my gosh,how in the world am I ever going
to do all of this.
You don't have to do all of it.
The goal is always just to beworking toward mastering the
things that are important andthen maybe you tweak Again.
Every time I go through theseI'm like, oh, I could add this
(23:07):
checkbox or that to mynote-taking and I just think
it's really, it's a goal, it's aprocess, it's not an end result
.
You don't have to have done allof these already.
Okay, oops, I should havetalked.
So we want a developmentalhistory for them and this can be
(23:28):
in your intake assessment.
You want it to be very thorough, as much as you can understand
the implications of what you'reasking about and consider what
their gender pronouns are goingto be, their cultural
affiliation, obviously, thepresenting problems.
Think about the currentdevelopmental level of
functioning.
One of the key requirements ofus as play therapists is to be
(23:52):
highly aware of developmentallyappropriate behavior, because if
a four-year-old, for example,is not a highly focused, very
adept, executive, functioninghuman, that's developmentally
appropriate.
That's their job.
So part of our job the APT bestpractices really prompts us to
(24:14):
be super aware of developmentalhistory and expectations and
being an educator for caregiversabout that.
The documentation should alsoinclude the level of family
functioning and environmentalassessment includes your long
and short-term goals oftreatment and the conditions for
(24:36):
a termination assessment andtreatment review.
Most of you already know whenyou have informed consent, one
of the things to include in thatat the beginning of treatment
is how treatment will conclude,and beginning that with the
parent at the beginning is abest practice because a lot of
times it's hard for parents todiscuss, to tolerate, to plan
(24:57):
for termination of treatment.
So that's something for us tothink about and help support
caregivers in that as we goalong.
We also want to include in yourdocumentation their overall
functioning and session observedplay themes, the materials that
they use and changes.
(25:19):
Changes are a big deal.
So changes in thought process,their mood or affect their play
themes, intensity of their play,their behavior.
I'm not going to lie, I've beendoing this a long time.
Sometimes I don't know exactlywhat it means, but I know to pay
attention to it and I have aform in my note taking to pay
(25:41):
attention to overall shifts,changes.
I know when things have neverdone this before and all of that
is really important.
We also, and as play therapists,this is it's the waiting room,
it's the handoff right, it'sthat transition.
(26:01):
So clinically significantobservations of clients with
their significant others.
I know those of you who seekids.
We in the waiting room.
You see a difference if mombrings or dad brings, or nanny
or grandparents, and any of thatthat's clinically significant.
(26:22):
You want to chart that.
You also can have and shouldhave in your notes clinically
significant observations of thesignificant others when they're
seen separately from the client.
So, for example, it's notuncommon for us to meet with
(26:43):
parents and have one parent ifit's virtual, like literally on
the side of the screen, orturned completely away from the
therapist all of which isclinically significant, just
indicating the level ofinvolvement.
I've also heard parents makingcomments in the waiting area.
(27:05):
Not all of it is clinicallysignificant, but some of it is,
and so that's the part that youdefinitely want to include in
your documentation.
You also should include graphicimages that are relevant to
their behavior and goals.
So this would be examples ofsketches of sand trays or
(27:29):
photographs is very common whenthey're deemed clinically
appropriate or for a justifiedrationale, like supervision.
If you're attaining yourregistered play therapy
certification, you know you haveto have your supervisor watch a
video of a play session.
Obviously, all of that would beonly with consent from
(27:50):
caregivers, also verbal andnonverbal expressions relevant
to their behavior and theirgoals.
So all of these should be inyour documentation and just
thinking about the best way todo that, because obviously all
of it has to be HIPAA compliantconfidential.
Another really important part ofdoing play therapy seeing kids
(28:14):
is to think about touch anddocument when it's used
therapeutically and ornon-therapeutically.
And APT talks about the factthat therapeutic or non-sexual
touch can definitely havetherapeutic value, but it should
be used very mindfully, with alot of education, supervision
(28:34):
and consultation.
And again, apt gives us anothergreat resource with their paper
on touch.
If you're working with kids andyou haven't reviewed it
recently, I really recommendthat you take a look at that.
Also.
(28:55):
It comes up with kids.
We need to recognize thatclients who have been sexually
abused or inappropriatelysexualized may initiate
sexualized play or inappropriatetouching of the play therapist
and when that happens, we needto take appropriate measures to
(29:16):
help them understand that it'snot appropriate.
And definitely you need todocument this, discuss the
incident and the interventionwith the clients and or their
caregivers, engage in peerconsultation, consult your
supervisor, do whatever you needto as soon as it occurs.
It's an important part ofworking with kids in an
(29:39):
appropriate way, and it'ssomething that we all should be
aware of, and it's somethingthat we all should be aware of.
We also, obviously, shouldinclude any suicidal or
homicidal intent.
For those of you that don'twork with kids, it may be
(30:03):
surprising to hear about this inan association for play therapy
recommendation, andunfortunately it does happen,
and so I'm documenting carefullyabout the incident, the
ideation, the plan and what therecommendations and steps taken
to ensure the client's safety,and this could include referral
(30:24):
to other services, consultationwith other service providers,
hospitalization.
All of that should be in yournotes.
And again, seek consultation,seek supervision if you need it.
Speaker 1 (30:39):
And we have a question.
Okay, Question is what if oneof the parents are the abusers?
Speaker 2 (30:48):
The question is, what if one of the parents are the
abusers?
Yeah, so you're required.
We're all mandated reporters,so we're required to report to
Children's Protective Serviceswithin 48 hours of learning of
the abuse.
Ideally, the family, thecaregivers, should be involved,
(31:10):
but not if that endangers thechild.
Speaker 1 (31:14):
Does that answer the question?
It was mentioned that we needto share with caregivers.
So, sabina, do you want tounmute?
You'll be on the recording.
So if you don't want to, that'sokay, or if you want to clarify
there.
Lynn, do you know what shemeans there?
Speaker 3 (31:29):
Yeah, I would not share with caregivers if you
believe it will endanger thechild know, when you notice that
there's some initiation ofinappropriate sexual like
touching from the child, um, ifwe want to initiate first with
(31:50):
the caregivers or just hold offand just kind of wondering how
to break that down even more.
Speaker 2 (31:56):
Got it, got it, got it.
And this is a delicate situationand I think that, um, part of
what you need to think about isprotection of your own role as
an adult in a room with thechild, and that's part of the
reason why APT really recommendsletting caregivers know what
(32:16):
has happened.
But I would recommend, if youhave a lot of concerns about the
safety of the child, againconsulting, supervising and
keeping in mind that 48-hourwindow.
If you believe that somehowthat inappropriate sexualized
touching indicates or may bepart of an outcry, does that
(33:03):
make sense?
I think so.
So, just to clarify, you'resaying that if there's happening
and I will bring it up withparents in a very general way,
so this is nothing.
This is not an outcry, this isnothing that the child has told
(33:25):
me or acted out somethingdevelopmentally outside of where
they should be.
But I've talked to parents andsaid in a pretty general way so
I'm wondering about anyinappropriate touching or access
.
Who has access to this child?
Because we don't know, we don'tknow, and so sometimes just
involving them in theconversation can help in a.
(33:45):
That would be in a general way.
Again, not if there is anoutcry.
Speaker 1 (33:51):
We have a follow up in the chat.
Okay, so share with caregivers.
When a child touches thetherapist, this would also
destigmatize touch with parents.
Many jump to abuse.
Sometimes kids are touching outof exploration as well.
Is this something you discusswith parents?
Speaker 2 (34:10):
Yes, the best practices do recommend that you
discuss it, and this is whereyour knowledge of
developmentally appropriateinformation and the appropriate
development for their age comesinto play.
And I agree, for their agecomes into play and I agree, the
(34:32):
vast majority of times thathave involved touch in the
playroom have definitely notbeen inappropriate or sexualized
in nature, and it is importantto document them and you can
discuss them with parents.
But if and I don't Um, but ifand I don't, you can just
sometimes get a feeling about achild's play and that is
(34:53):
something also to pay attentionto internally, document in a way
that is helpful to you and, ifnecessary, yeah, discuss it with
the caregivers.
Okay, okay, apt also talks tous about um, including progress
(35:16):
or barriers towards goals.
Here's where I remind us allthat anything that are in your
notes should be you should bewilling to have them read out
loud in a court of law in frontof caregivers.
So you want to be sure that ifyou see parents' failure to
follow recommendations as abarrier toward a treatment goal,
(35:37):
for example probably that'snever happened to anybody who
hears this you just want to beclear about how you're
documenting that.
That protocol would be okay foryou.
You also want to documentinterventions or coordination
with significant others, andthis would be family members,
(36:00):
teachers, pediatricians,psychiatrists, and this would be
in or out of actual sessiontime.
So adjunct therapy, referrals,I mean that's.
Another part of treating kids iswe have a lot of other people
that have a lot of informationabout these little humans, and
so there's a lot of outsideconsultation time and all of
(36:23):
that should be documented.
And obviously all of that wouldonly happen with appropriate
release of information.
Also, as much as you candocument medications, medication
changes, any side effects.
Sometimes you see kids come inwith a lot of mood changes and
(36:48):
parent may report to you thatthey've just had an increase in
a medication or a reduction.
Also, you want to document anyrationale for inactions taken
with regard to complying withyour laws.
So, for example, your informedconsent form, your, your
releases of information, if youhave a telemental health consent
(37:10):
form, all of those thingsshould be in your records.
They should all be there,consent to videotape if you need
to for supervision.
And after you've done all ofthis, all of it should be
safeguarded and kept with allrequired legal guidelines, so
like HIPAA.
So you've done all these thingsand I don't, I don't know about
(37:30):
you, but again I'm like, okay,yep, I got that, no need to add
that.
So that's a lot.
So, thinking about the rights ofour clients, minors they can't
legally give consent, but APTtells us that we should work to
(37:54):
obtain assent from minor clientsto treatment.
I don't think many of usactually do this and again I
challenge you to think aboutgaining assent from a
five-year-old to treatment.
How do you developmentallyexplain to them what's going on,
(38:17):
also provide informed consentto them and their rights to
confidentiality and limits to it.
So this is again where you flexyour knowledge, your
developmental knowledge muscles,because helping a child
understand what they're agreeingto, what you're going to keep
confidential and what you're notgoing to be able to.
(38:40):
There are cases some of you maydo court appointed treatment and
really best practice is to tellthat child from the jump.
You know what.
This is not all going to besecret.
Usually what you say or whatyou play is just going to be
between you and me, unless Ithought you weren't safe.
But in the case you know you'regoing to have to turn over your
(39:04):
notes.
You can't tell him that.
So you can tell him.
You know I will be letting yourmom's lawyer know about this,
or it's really.
Kids deserve to know thosethings and it's one of the I
will say for me it's one of thehardest parts of that kind of
client, that kind of job.
(39:29):
Also, consider the therapeuticrelationship when you are
thinking about treating multipleclients.
So there are some playtherapists and I don't have I'm
not saying there's a right orwrong with any of this who
absolutely refuse to everconsider treating clients who
are in a relationship with oneanother, for example, members of
(39:51):
the same family, cousins,friends.
Really consider carefully theadvantages and disadvantages of
doing this.
All parties should be aware ofrelationships and
confidentiality and obviouslyconfidentiality should be
protected and extended toeverybody who receives the
services and not just theidentified client.
(40:12):
So in this case you wouldn'ttell you know cousin's mom
what's going on with their nieceor nephew.
You have to really be sure, ifyou are going to do this, that
you're really carefullyconsidering what it's like and
keep very tight boundaries.
(40:33):
But there are times that it isyou may feel okay about doing it
.
Obviously, I've already talkedabout termination.
It actually gives caregivershope when we talk about
termination at the beginning oftreatment, because there's this
idea that it's not going to goon forever.
(40:53):
Their kid is not always goingto have to be in therapy.
Listen, I love my job but ifI'm doing it right, I'm going to
be able to graduate your childand we're going to hopefully
talk about this plan for it andgraduate them with them in the
loop.
Obviously, you don't abandonthem, you don't neglect them.
(41:14):
If you see that treatment is noteffective or treatment goals
are just not being met, referout as you need to Involve the
children in discussion andpreparation.
I think those of us who seekids just take this like.
Of course you would do that,but it's really hard for adults
sometimes to consider theirchild saying goodbye to somebody
(41:38):
who's been important in theirlives.
So be aware that the adultsmight have some really strong
feelings about this.
Sometimes the adults makedecisions about ending treatment
for them and the child is maybenot ready, definitely not on
board.
So, collaboration with thecaregivers to talk about ending
(41:59):
saying goodbye, talking to thechild about their thoughts and
feelings.
You may plan an activity thatdiscusses their treatment and
progress.
And then, importantly, APTadvises us to work with the
caregivers to prepare forpossible regression and
continued progress andrecommended action.
So telling parents you know,don't panic if things get worse,
(42:24):
it doesn't mean that thetreatment didn't work.
I'm going to be here, you cancall back if you need to, and
here's what you can do toprepare.
Another really hard part of ourjobs as child therapists is when
caregivers and legal guardiansare in conflict.
(42:44):
You want to be super clearabout what your legal guidelines
are.
Be clear in your informedconsent about what your role is
going to be, especially thatplay therapy does not constitute
a custody evaluation.
Texas law is very clear aboutwho are custody evaluators.
Also, clarify that for parents.
(43:06):
It's not uncommon for ourpractice to get calls for
parents who really are not clearabout what we can do for them
in the circumstance that they'rein conflict with their
co-parent or the child's othercaregiver co-parent or the
child's other caregiver.
You want to clarify yourobligation not to fulfill
(43:27):
multiple roles and that you aregoing to maintain
confidentiality, again with thechild as our primary concern for
keeping their confidentiality.
If there are caregivers or legalguardians with differing legal
rights and responsibilities, youstill need to obtain the
necessary authorization anddocumentation to be sure that
(43:50):
the appropriate person isobtaining treatment for this
child.
This is a tricky time sometimes.
I've had people really getoffended when I ask them for the
most recent file, stamped copyof the custodial orders.
Often they're in a divorcedecree.
They can come in other formats.
(44:11):
I've had people try to just pullparagraphs and tell me oh, this
is all you need, it's righthere.
When I stick to you know whatthe law requires me and best
practices requires me to be surethat the correct person is
seeking treatment.
It can be hard for some folks.
(44:32):
It also can be hard forcaregivers, who are highly
involved, but they may havelimited legal rights, so being
mindful and respectful of them.
Obviously you can collaboratewith them with the appropriate
release of information and again, that's part of what makes our
job hard as play therapists,because we are dealing with a
(44:55):
little person in the midst of apretty complicated system, and
so APT knows that and gives usthese ideas about how to
navigate it in the best way thatwe can.
Speaker 1 (45:07):
And we have a question two slides ago.
Sabina wants to know is onetermination session enough for a
child?
For example, if parents decideto take the child out of therapy
and their next session is thelast one, is that appropriate?
Speaker 2 (45:29):
their next session is the last one.
Is that appropriate?
The short answer that comes tomy mind is no.
That's not really enough time.
But another right answer is itdepends.
It depends on the child.
So, ideally, what I ask parentsfor is a three-session
termination process.
So you have time to introducethe idea to the child, you have
(45:49):
time to process it the next timeand the third session you
actually wrap it up.
Treatment ceases as soon as youstart talking about termination
, so that's important toremember.
If you can't get anything else,though, one is better than none
.
So if that's all they'll bringthem back in for and I mean, how
(46:09):
many times has that happened toy'all who see kids it's better
to just be able to say goodbye,tell them that you know that
that's what's up, to describewhat's happening for them.
Speaker 1 (46:23):
We have another question about the custody.
What do you do during theinformed consent if one parent
is not involved in the child'slife but there is no
conservatorship documentation?
Speaker 2 (46:38):
yeah.
So this is where it gets intoum.
It's not necessarily an aptbest best practices, but best
practices to support you as aclinician and to support your
practice.
So legally, you are well withinyour rights to go with, for
example, there might be just onecustodial guardian who has
(47:00):
rights to seek psychologicaltreatment.
You're well within your legalrights to move forward with that
caregiver's consent.
However, if you know thatthere's another parent in the
child's life, my lawyer has toldme best practice for me,
legally and practice protection,is to get consent from both
(47:22):
parents.
I have had cases recently wherethere is a highly contentious
situation and the divorce decreehas involved the use of a like
a pediatrician's recommendationas a tiebreaker.
So that's where I'm not goingto um.
(47:43):
I'm not going to advise you,but it's an area of concern for
those of us who see kids and Iwould be um.
Consult with your insuranceprovider, your liability
insurance provider.
Consult with um a lawyer, ifyou can.
Laurel Clements does a lot ofgreat continuing education.
(48:05):
Be really up to date on yourethical and legal
responsibilities, not just toyour client and their caregivers
, but also to you and yourpractice, because when a family
is in high conflict, it can getreally tricky.
We also talk about APT talks,about recognizing that again, as
(48:37):
I said, that clients may havereally important family members
or significant adults, and toinvolve them when you can and
with appropriate consent fromtheir custodial guardians.
To involve them when you canand with appropriate consent
from their custodial guardians,really try to be transparent in
treatment planning and treatmentgoals with those folks with
appropriate consent and, I wouldadd, with parents as well.
(48:59):
It's not uncommon for parentsreally to have no idea what
diagnosis their child is beingtreated for, to have no idea
what to look for, to know if thechild is getting toward their
treatment goals, to not knowwhat the therapist is
recommending I mean, I've hadparents report that I don't know
if it's always exactly true,but really be mindful of being
as transparent and informingfamily members with appropriate
(49:23):
consent.
And caregivers be mindful abouthow to honor their name and
(49:45):
pronouns, while being aware thatthis can bring up really
complex feelings for the familyand respecting where they are
with that.
It's really tricky and I knowthat any of you that already do
this you probably think about ita lot.
But balancing respect for theclient's right to privacy with
(50:06):
the caregiver's legal right tobe informed is one of the
hardest parts of our job, in myopinion.
So you really want to follow.
The laws obviously includelimitations to the
confidentiality in informedconsent.
We already talked aboutattaining appropriate assent to
treatment.
They can't waive their right toprivacy but they should be
(50:28):
informed if we are going to haveto divulge something.
For example, I tell kids if I'mgoing to meet with their
parents.
I tell kids if I'm going tomake a recommendation to their
parents that it's going to besignificant to them, like going
to make a recommendation totheir parents that is going to
be significant to them Likehere's what your mom wants you
to sleep in your own bed.
I'm going to be talking to herabout that.
(50:50):
It's part of my relationshipwith the child and they do
deserve to know that that'scoming up.
If the court orders you torelease confidential information
, seek legal and supervisoryadvice.
Again, your liability insurancecover may offer you this as
(51:11):
part of your policy.
Notify your insurance carrierregardless and seek to protect
the client privacy as permittedby law.
So obviously now you've got todivulge if you're court ordered
to, but you always want to seekto minimize disclosure and also
in supervision and consultationIn agencies on treatment teams.
(51:34):
I've talked to school counselors.
It's so helpful to see a childin an environment where you're
you know what's up, but it'salso very tempting for other
professionals to want to justget your ear.
Hey, did you see so-and-so?
And their mom dropped him off.
This is what happened and it'sreally best practices for us to
(51:54):
be mindful of holding that childand that caregiver's
confidentiality and not engagingin that kind of information
sharing unless it's very wellthought out and unless you have
consent to do it.
With telemental health duringCOVID, oh my gosh we had kids in
(52:18):
virtual sessions and it wasreally.
It was just like the Wild West.
It was so crazy and sometimesthis is the only way we can get
treatment to kids.
So obviously best practices areto use HIPAA compliant
tele-mental health platforms.
Work with your clients andcaregivers to set some
(52:39):
expectations so your client canhave some privacy and
confidentiality.
You want your own space to haveclient and confidentiality.
I just about always haveearbuds in, even if there's
nobody else around, so somebodycan't hear what's coming through
the other side of the screen.
(52:59):
You also best practice is tohave a direct method to contact
the caregiver if needed.
So if you're seeing a kid andthey start climbing on something
.
I've had them run out of theroom.
I've had them take the iPad tothe potty, so you need a way
honestly to text that caregiverlike, hey, we need you in the
(53:19):
room right now.
So that's an element of workingwith kids in tele-mental health
that we sometimes don't have toworry about.
With regard to taller people,and you want to address any
limits to confidentiality in theinformed consent With your
credentials.
Obviously you only representcredentials that you've earned.
(53:40):
Apt is very specific about howwe're supposed to represent that
.
So, for example, as aregistered play therapist
supervisor, this is the way itneeds to look and they've
trademarked that term and so Ineed to use that TM and that's
best practices for that.
Speaker 1 (53:57):
Lynn, we had one comment about asking parents to
turn off security cameras ifthey are in the telehealth space
to maintain privacy.
Speaker 2 (54:05):
Yeah, that's a good point.
Yeah, absolutely.
The other thing to think abouttoo, just to back up to the
telemental health, is thinkingabout if you have a child that's
in a situation that has beentraumatizing for them.
Take that into consideration,because perhaps they have
suffered something in the homeand you really need to be
(54:26):
mindful of that as you'reworking with them and someone
else in the chat just mentioned,and I really shouldn't say the
name because then like five ofthem will go off in my house.
Speaker 1 (54:36):
But Alexa, right that's true.
Speaker 2 (54:41):
It's true.
Yeah.
These are all things to thinkabout, and I think this speaks
to the rabbit hole that HIPAAfeels like to me and that ethics
feel like to me.
It just could keep going andgoing, and, again, the bad news
is, for somebody like me,there's no one right answer, or
there's no one decision treethat's going to get me
(55:03):
automatically to the rightanswer.
The good news is, though, thatwe really have some amazing
decision-making models that wecan rely on.
I'm going to kind of speedthrough these, because I'm not
going to tell you you have touse one or another of them, but
just knowing again that they'rethere and that you can follow
them to arrive at a decisionthat you know you know is
(55:25):
ethical and legal.
So there are tons of greatsources for them.
Aca has a gorgeous littlegraphic that's a decision tree.
They will guide you throughwhat your steps are, and then
you can document your followingof these to show that you are
ethically practicing, in general, a lot of commonalities to all
(55:51):
these different decision-makingmodels that are available to us.
In general, you identify theproblem or the dilemma, which
might be harder than you mightthink.
You want to prioritize them Ifthere's more than one issue.
You want to consider the impacton the client and your
relationships, review yourresources.
You can consult APT bestpractices.
(56:11):
What are your codes of law?
Maybe a consult with a lawyer?
And then you want to determineyour next best step, take action
and document that you have donethat.
This protects your license.
It protects your practice.
You want all of that in yourcharting the P3 model.
The way to find it is in theresources.
But basically it's beenpromulgated for play therapy.
(56:35):
It's very general.
I like it in that it thinksabout the principles that we are
adhering to as play therapists.
It considers the principals.
So who are the key players inthis situation and what's the
process that you're going to useto identify the principals,
(56:56):
consider how the principalsapply to the principals and then
how you're going to apply themin dialogue and how you're going
to document it.
We're not going to go throughhow that looks because we're
running out of time.
One of my favorite ethicaldecision-making models, dr Terry
Sartor and colleagues.
Here it is.
This is pretty amazing andhere's what I love especially
(57:19):
evaluating how the dilemma canimpact the child-parent
relationship, thetherapist-child relationship and
the parent-therapistrelationship.
So all of these are.
It's a very helpful way to stepthrough all of these.
Finally, I encourage you to comeup with an action plan.
(57:39):
I don't know about y'all, but Ihave a graveyard of notes I've
taken during continuingeducation where I've gone.
That's amazing, that's a bigaha, and then I get back to the
office and I get busy and Inever do anything with it.
So a handout that I providedfor y'all is to come up with an
action plan.
I really want you to spend justfive minutes after this.
(58:00):
Make a date with your calendarwith your rules and best
practices.
When are you going to checkthem for updates?
What items do you want to addto beef up your documentation?
What's your preferred ethicaldecision-making model?
You need any professionalcheckups, legal consultation,
supervision and what ethical,legal or other continuing
(58:23):
education do you want to do?
Do a little Google search, findthem.
Put them on your calendar.
Speaker 1 (58:28):
Hey, Lynn, we've got a request for that QR code again
.
Speaker 2 (58:31):
Oh, okay, let's see.
Oh for the handouts.
Speaker 1 (58:36):
Yeah, and while Lynn is looking for that, jennifer
posted the link one last time,so grab that link.
That's the only spot you'regoing to be able to get the
unique code as well.
Speaker 2 (58:46):
And, if y'all want me , I'm at learnplaytherapycom.
If you have gotten one of theseQR codes, you're going to be on
my mailing list for upcomingtrainings and I even if you
don't want to come to a training, I am happy to talk to any of
you.
Speaker 1 (59:01):
Lynn, I'm going to put that in the chat.
It's learnplaytherapycom and Iput Comic-Con, which doesn't
help anyone.
All right, check that out.
Is that correct, lynn?
Speaker 2 (59:16):
Yeah, let me look.
Speaker 1 (59:22):
That's it Okay.
That's it okay.
So everybody take a few minuteswhile we're closing and open
all of these links, because oncethe meeting closes, those links
go away.
Any last questions for lynn?
Just lots of thanks, lynn,you're, you're, thank you so
(59:43):
much for doing this and makingit relatable and accessible, and
it is.
It's just so much to know andso much to remember, and I'm not
a play therapist, I don't workwith kids and I learned so much.
So thank you for for making itaccessible for me and the me's
out there who are like me.
So everyone, please takeanother second I'm talking so
(01:00:09):
that you can grab those links.
And please reach out to Lynn.
She's got a podcast that'sgoing to be starting soon,
probably in the next couple ofmonths.
So look for that as well andget on her mailing list.
She's got a lot of cool stuffhappening soon.
So, lynn, thank you again.
Everybody, have a wonder.
Oh, and there's Terry's DrSartor's book.
Speaker 2 (01:00:31):
Yep, and this is where the ethical
decision-making model is from DrTerry and Sartor and I always
forget their first names, billMcHenry and Jim McHenry.
They are the ones.
Speaker 1 (01:00:42):
Will you read the title again?
I?
Speaker 2 (01:00:43):
know it's in the chat but.
Ethical and Legal Issues inCounseling Children and
Adolescents Cannot recommend ithighly enough.
Speaker 1 (01:00:51):
Excellent, all right, everybody.
Have a wonderful Thursday night, have a great Valentine's Day
tomorrow or whatever you'redoing on Friday.
And Lynn, thank you again somuch, I'll see everybody.
Speaker 2 (01:01:02):
Thank y'all.
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