Psychology students who seek to become practitioners dedicate years of their lives to studying and training, investing time and money in an education that will give them the skills they need to provide quality care. But what psychologists-in-training may not know is that even though they don't yet have their licenses, they can be as liable as their supervising psychologists and the hospital or clinic where they work if there is a complaint or lawsuit lodged against them.
In fact, each time a student psychologist provides care to a client, he or she risks allegations of malpractice, error or professional negligence, according to The Trust, a national provider of insurance and risk management programs for psychologists, psychology students, and related individuals such as social workers and marriage and family therapists. This is why most clinical training programs and sites expect or require students to carry insurance while seeing clients.
What could go wrong
In 1999, 15-year-old Penny Chang was shot and killed by a 21-year-old family friend who had become obsessed with her. Chang's family filed a $20 million wrongful death suit against the shooter's therapist — a student who was working toward a PhD and counseling patients under the supervision of a clinical psychologist — as well as the clinic that had discharged Chang's killer nearly four months before the shooting. In a subsequent trial in 2002, the jury ruled in favor of the therapist and clinic.
The claims against this student therapist were based on the 1976 landmark case Tarasoff v. Regents of the University of California, another tragedy in which a stalker who had been under a psychologist's care killed a woman who was the object of his obsession. This decision by the Supreme Court of California held that once a therapist determines, or reasonably should determine, that a patient poses a serious danger of violence to someone else, that therapist has a duty to use reasonable care to protect the targeted victim against that danger.
These cases are extreme examples, but they clearly illustrate the importance of students and licensed psychologists minimizing their risk and insuring themselves against lawsuits and complaints. Some other examples of malpractice allegations could involve accusations of a breach of confidentiality, an inappropriate relationship with a client (sexual, business, etc.) or failure to protect a client from self-harm. Other complaints can simply be dissatisfaction with the outcome of the care: A client might file a board complaint or a lawsuit charging, for example, that they didn't get better after 20 sessions.
Overall, as many as one in four psychologists will have a complaint filed against them in the course of their careers, according to Jana N. Martin, PhD, CEO of The Trust, though less than 5 percent will have to contend with a malpractice lawsuit.
Still, even when a complaint is settled in a psychologist's favor, he or she will need to have hired an attorney and will always have to answer "yes" when asked if they've ever been the subject of a complaint — which may complicate the process of getting a job in the future. That is one of the reasons why it's crucial for psychology students to practice good risk management, Martin says.
Smart steps for risk management
How can students protect themselves and reduce their risk of liability? Experts advise that you:
Be aware of state laws and keep up with changes. The laws and requirements affecting professional practices — such as record-keeping and confidentiality — vary from state to state, so find out what is specific to the state you are practicing in, which might be different from what you learned at the place where you did your previous training. Also, since state and federal laws and licensing board policies change often, students need to stay informed about any regulatory changes. One way to stay on top of these changes is to join the APA Practice Organization and a state psychological association.
It is also important to develop your knowledge about ethical and legal standards related to addressing credible threats of violence in your state or jurisdiction, advises Martin. For example, find out whether your jurisdiction has a duty-to-protect rule, and if so, what the law requires you to do when this situation arises.
Document diligently. Good recordkeeping is not only critical to providing high-quality care, it is essential for protection against a malpractice accusation. A good training program will teach students strong documentation skills and will supervise recordkeeping closely in risky situations — such as cases in which there is a risk of harm to oneself or others, or child or vulnerable-adult abuse is involved, says Nan R. Presser, PhD, director of training at the psychological services clinic at the University of Missouri–Columbia. Such cases call for high-density documentation, which includes such details as which treatment options were considered, which were chosen and why, quotes from the therapist or client that were relevant to the risk, notes of discussions with the supervisor and more. This type of documentation enables a case reviewer to follow the therapist's thinking, decision-making and actions in case of liability or treatment oversight, Presser says.
Learn how to avoid or navigate high-risk cases. Students should educate themselves about situations that put psychologists at risk for malpractice claims, such as treating a friend or acquaintance or engaging in a romantic or sexual relationship with a client. Child-custody cases can spell trouble as well. "Be careful not to recommend which parent should have custody unless a court appointed you to do so, you're properly trained in custody evaluations and you've done a comprehensive evaluation," says Martin.
Students should not make decisions by themselves in potentially risky situations; after all, that's why they are in training, says Presser. "Whenever there is any question or concern about a client, the student should quickly get a consult from his or her supervisor," she says. "If he or she is not available, hopefully the agency has other supervisors available who can be a resource to the student."
Also, be sure you know the chain of command and required procedures for reporting high-risk crisis situations.
Pay attention to your ethics training. "High-quality ethics training at the start of seeing clients and integrated throughout the training sequence is essential," says Presser. Ethics courses teach you to anticipate risk-management issues and steps to deal with them, and are an important part of preventing problems in training and beyond.
Educate your clients as well. Talk to clients about the limits of confidentiality and provide clear, thorough information so that their consent to treatment is truly "informed consent." Go over the patient agreement with them and discuss the structure of treatment, says Martin.
Know that having a supervisor doesn't relieve you of your responsibility. "Saying, 'I didn't know' or 'Somebody told me I didn't need to do that' doesn't absolve you and won't protect you in the event that an allegation of malpractice is made," says Martin. For example, if a student determines that there is a need to file a child-abuse report, but the supervising psychologist disagrees, the student still has a responsibility to go up the chain of command until he or she fulfills the ethical and legal responsibilities.
Find out exactly how your supervisor's insurance will protect you. Supervisors are usually covered for risks they incur because of their supervision of students, but their coverage may not protect the individual interests of the students themselves. If your supervisor tells you that you are covered under his or her policy, verify that and find out specifically what is covered. Don't be afraid to ask questions. The costs of defense counsel, court fees, expert witness fees and damages can be very significant.
Get your own insurance. Regardless of whether a student is covered under a supervisor's policy, it's a good idea for students to have their own policies. For one thing, a supervisor's professional liability policy will probably not cover situations in which you alone are at risk, such as when a complaint is lodged against you with a licensing board. Student policies cost less than $50 a year.
If you choose to get a policy, call your insurance company for a consultation about risk-management concerns at least once a year, suggests Thomas A. Pearson, an attorney in private practice in Bloomington, Minnesota, who manages the legal consultation service of the Minnesota Psychological Association. "It can save you money and problems."
For students training in industrial/organizational (I/O) psychology, having their own insurance may also be important. Whether they're hired as consultants or are on staff at a firm, I/O psychologists are often performing duties that could put them at risk for malpractice claims, such as evaluating an employee for a promotion, assessing an individual's sexual harassment behaviors or conducting a pre-employment screening.
In some cases, the I/O psychologist's report may be shared at the discretion of the company, which could leave the psychologist vulnerable to a lawsuit (say, if an employee were to allege that he or she didn't get a promotion or a job because of the psychologist's report). While the I/O psychologist may be covered under the company's insurance plan, the policy would most likely protect the company first and foremost. Students in I/O settings should be aware of these particular dangers.
Know that your volunteer work may not be covered. A student whose work at a clinic is covered under an insurance policy may not realize that any service he or she provides in a separate capacity, such as a volunteer at a shelter or church, will probably not be covered, says Pearson.
Take care yourself. Be aware of health issues or other problems you may be experiencing that could be interfering with your judgment, says Pearson.
"If you are compromised, it affects the quality of care and could show up in a complaint or civil suit."
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