Ethics Committee Chair — Katie Busse, MS, Registered AMFT

Changing Employment Settings: What about the clients?

At some point or another, we all go through transitions within our work lives. This may involve changing roles or leaving an employment setting. So if you’re a newly licensed clinician launching out, an established therapist deciding to move to private practice, or your employment setting is no longer a good fit for your needs, let’s talk about how to best support clients during this transition.

The most important thing to remember about clients is that they have autonomy and the right to make their own informed treatment decisions (CAMFT, 2011, Sec 1.5). When you leave an employment setting, the client has several ways to proceed with continuing their care. They can:

1. Go with you, assuming you have another appropriate practice or employment setting through which you could continue to provide treatment. For example, if you are pre-licensed, you need a new supervisor who consents to you bringing these clients to their practice (Leslie, 2007).
2. Stay at your previous place of employment and request to be reassigned to another clinician.
3. Receive services elsewhere (ensure that you provide referrals for additional local providers).
4. Discontinue therapy with the option of resuming treatment at a later time (CAMFT, 2011, Sec 1.5).

Now that you know what the client’s options are, how can you help them make an informed decision? Clients will need to be given adequate advanced notice to ensure enough time for termination (CAMFT, 2011, Sec 1.31). Collaborate with your specific employer on how to inform clients of your transition (Leslie, 2007). You may want to inform clients in writing, such as via email if this is a previously established method of communication, so that you have a record of notification. Be sure to document attempts you make to inform the client of your transition and their future treatment options.

In the event that a client inquires as to why you are leaving your employer, be thoughtful with your response (Griffin, 2017). If you are leaving to start your own private practice, congratulations! The client may be happy to learn about the next big step in your career. However, if you are leaving your employer due to conflicting values, ethical concerns, etc., it is best to refrain from disclosing that information to the client. This type of disclosure would not be therapeutically relevant, and it would be inappropriate to speak ill of your previous employer (Griffin, 2017).

So, if the client decides to transition to another provider or discontinue therapy, then proceed with an ethical termination process. However, if the client decides to continue treatment with you, here are some next steps to take. With regards to your fees, the best practice is to keep each client’s current rate the same at your new place of employment. Increasing the fee could open up questions of possible exploitation while lowering the fee could be seen as trying to coerce the client into leaving the previous employment setting (Leslie, 2007). Since the client will continue treatment with you at a new practice, they will need to sign a new informed consent that outlines the policies of that new setting. On a final note, remember that the client’s file will remain property of the previous employer, and the client would need to complete a release of information to allow you to request the file at your new practice.

Disclaimer: The preceding article does not constitute legal advice. Always consult with a CAMFT attorney or another legal professional for any legal or ethical questions you may have.

References and for additional information: California Association of Marriage and Family Therapists [CAMFT] (2011). CAMFT Code of Ethics. Retrieved from www.camft.org/Portals/0/PDFs/AssocDocs/CodeOfEthics.pdf?ver=2019-06-04-093935-577 Griffin, M. (2017). Thoughtful Transitions. The Therapist. Retrieved from www.camft.org/Resources/Legal-Articles/Chronological-Article-List/thoughtful-transitions Leslie, R. (2007). Termination of Employment: Who "Owns" the Patient? CPH & Associates. Retrieved from: www.cphins.com/termination-of-employment-who-owns-the-patient/.

Katie Busse is a Registered Associate Marriage and Family Therapist (111673) in private practice under Tamika Mazariego, LMFT (102089), where she helps teens, young adults, and families. Learn more about Katie by visiting her website at www.katiebussetherapy.com. She can be reached at 747.217.2257 or katie@katiebussetherapy.com.