Thank you Dr. Maelissa Hall for your guest post.
Forms and policies are one of the least exciting things about having a private practice, but also one of the most important. Your policies provide the framework and boundaries for your treatment with clients. They also protect your counselor booty in case questions come up later down the line.
Unfortunately, I’ve seen many well-meaning and excellent therapists make mistakes with their forms and policies. And I don’t want that to be you! I’ve created this list of the most common mistakes I’ve seen from other therapists in private practice so you can avoid them and start off on the right foot.
Mistake #1: Not actually reviewing forms with clients.
Pretty much every counselor has a set of forms clients are required to sign at the beginning of therapy. However, many counselors never review these forms with the client! I get it, going over forms is boring and you want to focus that first hour on building rapport and making sure the client is a good fit. But starting out the therapeutic relationship without actually reviewing what that means can have very negative consequences for your clients (and you!) down the line. I recommend starting out with a friendly discussion about what the client expects, what you expect and how you work. The forms serve as a guideline for that discussion but the talk is really focused on the clinical meaning of the forms and the therapeutic relationship, not initialing next to paragraph #2, #3 and #4 and then signing at the bottom of the page.
Mistake #2: Not understanding the purpose of a form versus a policy.
Forms and policies are two different things and understanding the difference will help you perfect each one. Policies are your set of procedures for how your practice works. For example, you should have a no show and a cancellation policy. This outlines how you expect your client to act (e.g. call 24 hours in advance for cancellations) and how you will respond in kind (e.g. no charge for sessions cancelled 24 hours ahead of time or no charge for sessions cancelled due to an emergency). Forms are simply these policies written on paper so everyone has a clear understanding. Your signed private practice forms are your proof that you’ve reviewed the policies with your clients.
Special note: Include a statement about reviewing your policies and informed consent in your first session note. This documents that you actually took the time to review the policies rather than accepting a signed form your client may have never read.
Mistake #3: Questioning their policies without adjusting.
It takes a little time to figure out what works for you- what kind of schedule you want, the type of clients you enjoy working with most, and the easiest way for you to handle logistics (like whether or not you send clients to your website to download forms before the first session). I see many therapists who have policies they often don’t follow themselves. For example, they might let a favorite client slide on the 24 hour cancellation notice because they have been in treatment for over a year and usually very consistent. Or they may hate charging a client’s credit card at the end of every session because of the time it takes away from the therapy hour. Want my simple answer to these problems? Change it! This is your practice and it makes sense that you’d want to change some things as time goes on. And you have every right to do so, provided you give your clients fair warning. I recommend that you review your forms and policies once a year to ensure they still make sense for you and your clients. If you notice something that doesn’t feel right or that you want to change, change it and let your clients know. Simple as that!
Mistake #4: Copying from someone else and losing their uniqueness.
Your forms and policies are just that- YOUR forms and policies. While some therapists purchase forms from a lawyer or other therapist, the majority actually just copy a form from a colleague or past supervisor. Sharing is a wonderful thing and I definitely agree that having a template to start with can save a ton of time. However, when you take a form from someone else and simply swap out your name and address you lose so much value. Clients have choices among dozens, and depending on where you practice possibly hundreds, of therapists. But your clients chose YOU. There was something about your style that spoke that to them. And since your policies and forms are an integral part of your practice they should reflect who you are. I recommend reading through your forms carefully. Does the language sound like you? Is it professional but also taking into consideration your typical client? Depending on your specialty you may want to adjust phrases and wording so that it makes more sense for your clients and truly reflects your practice.
Mistake #5: Leaving forms incomplete.
You’ve put in the time and effort to create policies that matter to you and personalize your forms. So, if there’s a section on your intake form, for example, that you often overlook I recommend you evaluate if it really needs to be there. We’ve already established that your forms have a clear clinical purpose and if they’re only partially completed the clinical meaning is likely missing from that section. When you do your annual evaluation of your forms see if there is anything you want to adjust. Maybe it’s just a matter of condensing two similar sections or changing the wording a bit. And if it’s something that doesn’t seem to matter after all, take it out! Unless, of course, it’s related to our last mistake…
Mistake #6: Not doing research ahead of time on state regulations and ethical guidelines.
Since most counselors end up copying someone else’s forms, they assume the forms are good to go. I mean, if your supervisor was using it, the form must be up to date on state regulations and ethical concerns, right? Unfortunately, no. Many seasoned therapists are actually NOT up to date on many regulations simply because it can be difficult to do so and there’s rarely a marching band coming to their office announcing each change when it happens. However, that’s not an acceptable excuse for neglecting these guidelines in your policies. Make sure to do your own research on things like how long you’re required to keep client records, in what circumstances you can share records of minors, and when you’re mandated to break confidentiality. These are the standards you’ll be held to if ever questioned about your actions and it’s important to make sure you know how to act when ethical dilemmas or questions arise.
Now, take action! Don’t let fear of litigation paralyze you into ignoring that voice in your head that just said, “Oh crap, I need to change that!” It doesn’t need to be a big ordeal. I recommend getting together with a trusted colleague and reviewing your forms in collaboration, keeping these common mistakes in mind. You’ll get a second opinion and it will make the task more enjoyable. You can also sign up for my monthly newsletter (https://qaprep.leadpages.net/paperwork-crash-course/) for more tips on all things documentation. Happy writing… and revising!
Dr. Maelisa Hall specializes in teaching therapists how to connect with their paperwork so it’s more simple and more meaningful. The result? Rock solid documentation every therapist can be proud of! Check out her free online Private Practice Paperwork Crash Course (https://qaprep.leadpages.net/paperwork-crash-course/) and get tips on improving your documentation today.