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[AnonymousPsyDoc]

xxx

Thank you very much for your thoughts everyone. Editing for privacy reasons.

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[thebalmofhurtminds]

This can't be serious.

 

[WisNeuro]

If this is not a joke or bad trolling attempt, I would definitely run this by your liability carrier, as well as your own legal counsel. This sounds like a lawsuit just waiting to happen.

 

[AnonymousPsyDoc]

This can't be serious.

This is 100% serious.

 

[WisNeuro]

Personally, I would refuse due to liability. At the very least, you are asking people to drive distracted. At the worst, you are asking people to drive very distracted in emotionally turbulent states. I can't imagine they will be attending very well to either therapy, or the road. Hard no.

 

[WisNeuro]

First, get their ask to do this in writing, and document it all very carefully. Seek out opinions from your liability carrier and legal representation. Next, outline your reasons for why you will not provide this service. If they threaten termination or firing, seek legal help.

 

[Sanman]

First, get their ask to do this in writing, and document it all very carefully. Seek out opinions from your liability carrier and legal representation. Next, outline your reasons for why you will not provide this service. If they threaten termination or firing, seek legal help.

This. Definitely get it in writing and check with your malpractice carrier for legal liability. I would also consider contacting any ethics board that might be part of your state licensing org/state psych association. If there is liability or licensing considerations, bring this up with your employer. You can decide if you want to leave after that, take legal action, or just refuse to do it with your patients as you do not feel it is appropriate. I would never present my patients with the option even if the org encouraged this.

 

[R. Matey]

I would also consider contacting any ethics board that might be part of your state licensing org/state psych association

If you're an APA member, this is a good opportunity to call the ethics hotline. I know some state orgs have similar mechanisms.

 

[Fan_of_Meehl]

Our org has asked providers to conduct virtual therapy sessions, mostly groups, while patients are actively driving their cars, if the patient wants to do it this way. The justification is increasing access to care, and as such, reducing potential harm from having to reschedule. There are obvious issues here, but how would you handle this situation?

This is one boundary (no driving (distracted and likely crashing) while participating in intensive psychotherapy via cellphone) that any reasonable practitioner or organization must uphold.

I mean, in many (most) states, it's illegal to use a cell phone while driving, anyway.

 

[Fan_of_Meehl]

This is 100% serious. Unfortunately. Orders are coming from licensed MH leadership.

Sadly, it sounds pretty typical of 'licensed MH leadership' these days.

On other topics, I have had to remind people that we simply cannot be ordered (validly) to break the law (or assist our clients in breaking the law). Don't know your state laws on use of cell phones while driving but, if it is illegal to do so, that would be an easy thing to point out.

 

[Sanman]

One other thought, if clients can be driving during session, can therapists? Why be in the office at all? Can I run errands while seeing clients? It's cool to put them on hold while I order lunch, right?

This is how I imagine operating as a Betterhelp therapist.

 

[pediatric_psydoc]

My organization has documented in the group and individual therapy guidelines that no one is to be driving while obtaining services.

Another component to this, along with what others have already mentioned, is we don’t know exactly where they are driving and they may be in another state in which we are not licensed. Especially risky in locations where people regularly cross state lines (e.g., Kansas City metropolitan).

 

[JeyRo]

Our org has asked providers to conduct virtual therapy sessions, mostly groups, while patients are actively driving their cars, if the patient wants to do it this way. The justification is increasing access to care, and as such, reducing potential harm from having to reschedule. There are obvious issues here, but how would you handle this situation?

Saying this seems like a dumb idea would IMHO be criminally understating things

 

[Fan_of_Meehl]

Saying this seems like a dumb idea would IMHO be criminally understating things

I'm just imagining the awkwardness of trying to manage all the various members of the group, Hollywood Squares style, while they variously: run redlights, pick up their children from school and engage them in conversation, and make a quick trip to the liquor store during their telehealth psychotherapy sessions.

 

[Sanman]

My organization has documented in the group and individual therapy guidelines that no one is to be driving while obtaining services.

Another component to this, along with what others have already mentioned, is we don’t know exactly where they are driving and they may be in another state in which we are not licensed. Especially risky in locations where people regularly cross state lines (e.g., Kansas City metropolitan).

To add to this, what do you do if there is a threat of imminent harm? We generally document location and closest available emergency services at the VA. You going to call the cops on a moving vehicle?

 

[smalltownpsych]

Agreed. For all the obvious legal, ethical, clinical reasons. To my surprise many mid levels were okay with this, but perhaps they are just doing what they are told.

How would you all approach this with leadership? Would it be wiser to just refuse case by case as patients get booked and login? Document document document? Blanket statement to leadership in writing? Other thoughts? An initial conversation happened but nothing much changed.

I am surprised that you are surprised that the midlevels were okay with this. I’ve been working with midlevels for years and it seems like about half of them are okay with just about anything.
The way I would deal with it is to tell my patients that we can’t talk until they can find a safe place to park. I have had sessions with patients who are in cars, parked. I would not waste my breath arguing with the agency unless you are in a leadership role. If you are not in a leadership role then I don’t think you would be liable for stupid things that others do. And yes, it is incredibly stupid on their part.

 

[AcronymAllergy]

I'll add to the chorus of folks saying I would absolutely refuse to do this. I also agree with the recommendations above to get the request from leadership in writing, go to your malpractice carrier (and professional practice/ethics hotlines) with it and get their response(s), and to focus on the various liability issues. Therapy sessions can be emotionally intense. Do we want someone trying to drive while they're sobbing or recounting an emotionally-charged experience?

From an engagement perspective, would we allow patients to play a driving simulator game on their phones while they're in session with us? How about playing a game on their Xbox or PS4 while we're doing a remote session? Probably not, unless that were actually part of their therapy session.

 

[Fan_of_Meehl]

Our org has asked providers to conduct virtual therapy sessions, mostly groups, while patients are actively driving their cars, if the patient wants to do it this way. The justification is increasing access to care, and as such, reducing potential harm from having to reschedule. There are obvious issues here, but how would you handle this situation?

From a broader perspective, this situation appears to be at the intersection of a couple of disturbing trends that have been accelerating over the past couple of decades in mental health:

(1) The trend of 'higher up' managerial/admin types (license or no) being increasingly motivated to be increasingly involved in micromanaging and dictating specific details of how the therapy will be conducted (and, generally, in the form of stupid 'one-size-fits-all' policies/procedures) while failing to solicit input from the providers who hold the same degree and have more experience in actually implementing the therapies on a day-to-day basis. These come in the form of micro-dictates, generally by email or by brief matter-of-fact mention in staffing meetings to the effect of: "You will need to start doing X because Y reason (if a reason is given at all)" and the reason is either transparently motivated by political/organizational non-clinically relevant factors or absolutely no rationale is given whatsoever. Any questions/concerns or attempts to clarify the request and how it may affect clinical care (generally, adversely) is perceived as an attack on the person/system handing down the dictate and responded to quite defensively, usually including a reactive 'barb' back at the questioner. For example, hypothetically, let's say there's a shiny new policy/procedure that's being implemented (with the ostensible aim of, of course, 'eliminating suicide' or something...unquestionably noble) that mandates that providers do something that may actually interfere with therapy or the therapeutic relationship and which may not actually result in the desired outcome, especially if it is blindly and automatically implemented across the board with every client in every situation no matter what. Any questions that providers voice (or objections) to the proposed (mandated) 'new procedure' is conceptualized as 'resistance' or with some other negative connotation. "I mean, you providers don't want people to *kill* themselves by suicide do you? Don't tell me that you don't care about the scourge of suicide and you don't love veterans like *I* love veterans (and I am demonstrating my love of veterans by enforcing policies/procedures, no matter how stupid, no matter how logically flawed and empirically false)." There are typically a half-dozen or so thought-terminating-cliches peppered into the language but I can't bring my self to reproduce this without getting slightly nauseous.

(2) The trend of mental health care services (especially in large organizations but, really, everywhere) being infused with a philosophy of care of adult psychotherapy clients characteristic of the philosophy of customer care in a retail business ('the customer/client is always right...whatever they want...we exist to 'please' the customer and curry favor with them and get good 'feedback' on customer satisfaction surveys') and/or a philosophy of care of adult psychotherapy clients characteristic of the philosophy of administration of class to helpless innocent children in a kindergarten or daycare setting. Neither is appropriate in the least.

 

[allantois]

Common sense isn't so common. I get absolutely furious when patients try to pull this crap (or being at the mall or a number of other public places), but most of the times they are 5 mins away from the house or trying to pull in somewhere

 

[singasongofjoy]

Good lord. This is terrifying. In addition to the obvious inane nature - also depending on the age of client and/or state and method could also be having your client to do something illegal (e.g. do they have full driving license, permit or some graduated permit, limitations on their driving license / conditions?) Do you have the type of relationship where you could ask the licensed MH clinician director from whom this is coming down whether or not they have run this by their own licensing board ethics folks? I assume any such board would close that down STAT