The Ethics of Other People Writing Your Treatment Plan

The Ethics of Other People Writing Your Treatment Plan

QUESTION

Is it ethical for one therapist to write a Treatment Plan for another therapist to use?  At my group practice, I’m often asked as a licensed therapist to do an Intake and write the Treatment Plan to hand off to a master’s level therapist for therapy.  This just doesn’t feel right to me. Is it legal?

ANSWER

I can’t tell you that this process is legal because that’s out of my scope of practice.  But I can tell you that the process you describe is often done at agencies and clinics and was even eventually implemented at the agency where I used to work.  So, I assume the practice is legal.

As for ethical – why not?

Pros and Cons of Another Therapist Writing Your Treatment Plan

At first, I didn’t like the idea of having another therapist do the intake and treatment.  But upon further thinking, I see a couple positive outcomes. Let’s review the cons first…

Cons

1. Working from a pre-written treatment plan can feel limiting to the therapist who has to work with it.
2. If the licensed clinician is writing the treatment plan and handing it off to the master’s level clinician, the master’s level clinician is not getting experience writing an important clinical document.
3. Conversely, if the master’s level clinician is writing all the treatment plans, but not providing therapy, the master’s level clinician doesn’t get the experience of seeing how the Golden Thread is carried through from intake to discharge from a purely clinical perspective. In other words, they don’t get to practice doing therapy.
4. These practices limit clinical learning and perpetuates the lack of documentation training endemic in the profession and restricts learning.

Pros

1. On the other hand, at least interns and master’s level clinicians get a lot of experience writing treatment plans, which is a needed skill.
2. The process speeds up access to services! Given the demand for mental health services, this is a big plus for therapists, as well as the client.
3. You may have more time to focus on your client or yourself.  Less paperwork on your plate means less burnout.

So, as long as there is a balance between writing treatment plans and providing therapy, why not?

There’s a good clinical way to manage the feeling that your treatment is being imposed upon. Use your first couple of sessions to learn more about the client based on the information in the treatment plan.  Review the plan with the client to determine if the client is on board by asking clarifying questions.  Amend the diagnosis and fine tune the plan if necessary.  It’s a lot like doing the diagnostic interview yourself.  If there are no amendments, you are saved the (unpaid) time it takes to write the plan.

Why is Good Mental Health Documentation Important?

Having another therapist write your treatment plan is not unethical. It simply needs to be managed in an ethical way. It’s perpetuating the lack of documentation training that’s unethical.

Good documentation supports good clinical practice and helps mental health professionals and clinics pass insurance audits, saving thousands of dollars in potential recoupments and wasted time. It helps reduce “documentation anxiety” and increases job satisfaction.  Rather than being an afterthought, good documentation will reflect the high-quality clinical work you are doing. If you want to feel confident when it comes to mental health documentation, consider taking my online course, Misery or Mastery: Documenting Medical Necessity for Psychotherapists.