Lessons From Bad History and Good Sense

Gary R. SchoenerLicensed Psychologist & Executive Director

Walk-In Counseling CenterMinneapolis, Minnesota

The law isn’t justice. It’s a very imperfect mechanism. If you press exactly the right buttons and are also lucky, it just may show up in the answer. A mechanism is all the law was ever intended to be.Raymond Chandler, American author, 1953The Long Goodbye, chapter 8

Outcomes of legal cases…

Relative skills & prep. by each side Jury or tribunal/panel hearing the case Judge or hearing examiner’s rulings Chance events; happenings in hearing Physical appearance & demeanor of all Whether judge/jury believe key people Role of media coverage or context

A few important notes

• When faced with possible legal risk, remember that the key is to do your thinking and get consultation

• The standard of care is what a reasonable and prudent professional like yourself would do in the same or similar circumstance

• The most important courtroom is the mirror in your home into which you look in the morning and evening

Why Things Go Wrong…• Poor training & preparation of

those who will staff a new program;• Various types of psychopathology in

staff or leadership;• Failing to adequately assess & deal

with pathology;• Unusual stress affects staff member

or leader’s ability to do the job;• Inadequate staffing or program

design;

BOUNDARY CROSSINGS

• Myth of the Slippery Slope: There is not good evidence that one boundary crossing leads to another – however, if boundaries are being broken down there may be a succession of crossings.

• Myth of the Small Violation: Some times a seemingly minor crossing is ignored – it could be the beginning of a major breakdown or simply the one visible sign of it.

… Reasons Things Go Wrong

•  Attempting to be all things to all people – particularly challenging patients – failure to locate or create alternative programs (e.g. DBT in the USA);

• Leadership over-promises complainants or others as to what they can do;

• People who are inept do dumb things and don’t get consultation;

• People act too fast without planning;• People stick to a policy, even when it does not fit a situation.

Practical training re: boundaries with videotapes, role play, presentations by offenders and victims;

When a trainee shows evidence of impairment have a thorough assessment done; plan rehabilitation and review student’s future;

Deal with abusive faculty & admin. – those with “regal bearing” who “can do no wrong” are bad models.

Trainees benefit from learning of faculty mistakes from their own experience.

Issues in Training

Criminal justice background checks; Obtain a broad release permitting you to interview anyone about their work history, skills, character and ethics;

Ask for and provide honest feedback about strengths & weaknesses;

Ask reference to specifically reflect on the specific job and what reservations they might have;

Be clear with applicant about the major challenges & stressors – what the “real” job is like.

Use role play or get a work sample.

Hiring of staff

Ensure that your supervisors are trained in supervision; have consultation group;

Set up supervision plan & probation for a new staff member based on their strengths and weaknesses;

Review the plan periodically; Have back-up supervision & a clear

standard that consultation is obtained; With lacunae in training or skills,

develop a plan for additional training, supervision, etc. & evaluate success

Supervision

Have policies related to key areas where there are boundaries challenges;

Define who is a patient and what rules apply to those who are family members or connected to the patient;

Define boundary issues with regard to former patients;

Have a standard that staff, when in doubt, obtain consultation.

If there is an area of special challenge, address it through a staff discussion.

Policies & Procedures

1) Failing to empathize with the anxiety involved in a complaint;

2) Jumping to a premature conclusion –failing to investigate;

3) Promising a response within a time frame which is unrealistic;

4) Failing to give a simple human apology for what has happened or the apparent impact;

Common Errors in Handling Complaints ….

…more common errors

5) Getting so legalistic that all comfort or sense of comfort is lost;

6) Hinting at an outcome or giving false reassurance when things are uncertain;

7) Not allowing the complainant time to think over a choice; not having them talk it over with their support people;

8) Being careless in what information is put out to the staff or the community.

Challenges of the Internet

Complaints/grievances may end up being “public” on the internet

Great new hazards re: boundaries;

Be aware of your web-presence – google yourself, staff, your program;

If there is false information, contact site administrator to get things changed

Collegial discussion – develop standards

Consent & Disclosure Issues

What ground rules will you have for a given unit, program, or practice as far as googling?

If you do google someone, will you disclose this to them?

What rules if any will you ask patients to follow as regards the internet?

Will you ask them to maintain any privacy or respect any boundaries?

grschoener@walkin.org