Nov 25

Gratitude Journaling

Gratitude Journaling

Screen Shot 2015-11-25 at 12.39.29 PM

Stay Thankful this Holiday Season with Gratitude Journaling.


Our lives are so often consumed by stress that we rarely pause to consider all that we are thankful and grateful for. Instead, we often focus on the stresses of work, education, financial, friendships, relationships, and conflicts within the family. We only briefly consider the joyful people and things that also fill our lives.


In the spirit of the holidays, bring gratitude to the forefront of your thoughts with Gratitude Journaling. Gratitude journaling is a log kept of all the moments, people, and things in your life that you are grateful for. Ask yourself what you are grateful for each day and write down these thoughts as they come to mind. You may surprise yourself with the large amount of entries you have!


Many celebrities and notable philanthropists have incorporated gratitude journaling into their daily routine. Oprah Winfrey is strong advocate for daily gratitude journaling, and notes that there is always time for it in the day. When she had temporarily stopped her daily gratitude journal, she noticed a shift in her mood; she wasn’t as happy anymore. At first she told herself she was just too busy to log daily, but then reflected on how her life was just as busy before when she was journaling daily. Oprah now writes her journal electronically, and writes it down the moment the grateful thought comes to mind. It’s all about prioritizing your journal and making it as accessible as possible, such as writing it down on your phone or a notebook you keep handy.

For more articles on mental health, visit our CPH Blog

Nov 17

Update: The Texas Association for Marriage & Family Therapist Case

This blog is an update to our previously posted blog outlining the current case in Texas regarding the Right to Diagnose for Texas MFT’s: 


The Texas Association for Marriage and Family Therapists backed legislation during the 2015 Texas

Legislative Session (HCR 84) that read in part:

“RESOLVED, That the 84th Legislature of Texas hereby directs the licensure Board governing the state’s

mental health providers to use the Diagnostic and Statistical Manual of Mental Disorders, the

International Classification of Diseases, and any other appropriately recognized classification systems,

and billing codes therein, for evaluation, classification, treatment, and other activities by their licensees

and in connection with any claim for payment or reimbursement from a health insurance policy issuer or

other payer…”


Although this bill had overwhelming bipartisan support in both the State House and Senate, Governor

Glenn Abbott vetoed the bill on May 18, 2015. The intent of this language in the bill was to provide a

work around for the 3rd Court of Appeals decision in the suit filed by the Texas Medical Association

against the Texas State Board of Examiners of Marriage and Family Therapists and the Texas Association

for Marriage and Family Therapists. That decision barred LMFTs in Texas from making client diagnosis

using the DSM or ICD in their practices. The decision is being appealed to the Texas Supreme Court.

The intent of HCR 84 was to instruct the relevant agencies to maximize the tools available to them, to ensure

that licensed, qualified mental health practitioners were eligible for reimbursement by insurance payors. It

deliberately avoided using the term “diagnosis” and instead focusing on currently permissible activities

including evaluation, assessment and treatment in a manner consistent with the classifications and billing

codes contained in the DSM.


State studies documented that 173 out of 254 Texas counties are designated as Health Profession Shortage

Areas (HPSAs) for mental health. If LMFTs and other licensed mental health professionals are unable to

practice given the uncertainty of reimbursement, these shortages of access to mental health care will



All mental health professionals without medical licenses need to get involved and support the efforts by

the SBEMFT and TMFT to assist in this battle against TMA. Ways to help include reaching out to

legislators, contributing to the TAMFT Political Action Committee (PAC) or the Practice Protection Fund

set up by AAMFT.


An interesting side note: According to Governor Abbot’s campaign finance reports the TMA PAC

contributed $43,485.41 to the Governor in 2013 and 2014.

Nov 12

Coloring Books: Not Just for Kids

Coloring Books: Not Just for Kids

Meditate through Coloring Books

Screen Shot 2015-11-12 at 12.40.38 AMRemember the childhood days of spending hours carefully coloring in the pages of a color book with crayons and markers? According to recent studies showing the benefits of meditation through art therapy, it may be time to pick up the coloring book again.

Everybody experiences stress, whether it be physical stress, mental stress, financial stress or emotional stresses. We encounter these magnitude of stressors throughout any given day, all of which can take a toll on our physical health, vitality, and happiness. Meditation, in addition to regular exercise and a healthy diet, can decrease this stress to promote longevity and a positive mental state. According to Psychology Today, meditation is the practice of turning your attention – or bringing awareness – to a single point of Screen Shot 2015-11-12 at 12.40.47 AMreference. This point of reference can be your breath or body, but must be in the present moment. The purpose of meditation is to clear the mind of existing external thoughts. Unsettling thoughts, such as relationship and life issues, melt away while meditating. Meditation provides people with a deeper sense of self-connection and mental clarity.

Meditation can be practiced in a multitude of forms. Art therapy has become a widely acknowledged, contemporary form of meditation. The American Art Therapy Association describes art therapy as a “life-affirming” expression that can aid in melting away stress, and enables people to focus on the singular task at hand: the art that is being created in the present moment. Drawing in a coloring book is a simple, but highly effective, way of practicing art therapy. The next time you feel overwhelmed with stress, pick up a colored pencil or marker, and let your focus and stress melt into the pages.

Stressed at the workplace? Check out more of our latest tips on stress management with 5 Easy Ways to Beat Stress at the Workplace.

Oct 20

The Right to Diagnose for Texas MFTs


On November 21, 2014 the Texas Court of Appeals, Third District, At Austin in Cause No. 03-13-00077-CV issued its decision in a case brought by the Texas Medical Association (TMA) against the Texas State Board of Examiners of Marriage and Family Therapists (TSBEMFT) and the Texas Association of Marriage and Family Therapists (TAMFT). The court invalided a TSBEMFT board rule (22 Tex. Admin. Code §801.42(13)), which stated that a marriage and family therapist may provide “diagnostic assessment which utilizes the knowledge organized in the Diagnostic and Statistical Manual of Mental Disorders(DSM) as well as the International Classification of Diseases (ICD).”  The case had been assigned to a three judge panel and resulted in a 3-2 decision in favor of TMA on this issue.

The deciding two justices, Justice Scott K. Field and Justice Bob Pemberton reasoned that TSBEMFT exceeded its authority granted by its enabling statute, the Licensed Marriage and Family Therapists Act (Texas Occupations Code, Chapter 502) in implementing the rule cited above. Texas Occupations Code  §502.002(6) allows marriage and family therapists to provide “professional therapy services “ including “evaluation of …cognitive, effective, behavioral, or relational dysfunction.”

The majority found that “evaluation” did not mean “diagnosis” which they opined is reserved to medical doctors under the Texas Medical Practice Act (Texas Occupations Code, Chapter 152).  Under the Texas Medical Practice Act “practicing medicine” is defined as “the diagnosis, treatment, or offer to treat a mental or physical disease or disorder or a physical deformity or injury by any system or method, or the attempt to effect cures of those conditions.”

The dissenting justice J. Woodfin Jones, the Chief Justice, wrote a dissenting opinion in which he accused the majority of playing a semantics game and for not adopting a more general definition of “diagnosis”. He wrote that “no therapist could hope to successfully remediate ‘cognitive, affective, behavioral or relational dysfunction’ without performing a ‘diagnostic assessment’ (in the general sense) of the individuals involved, and any therapist who attempted to evaluate an existing dysfunction in a marriage or family without considering clear mental and emotional issues of the individuals involved would likely be committing malpractice.”

TSBEMFT and TAMFT are appealing this decision to the Texas Supreme Court and the decision has been stayed pending the appeal.  If the decision is allowed to stand Texas LMFTs will be unable to make a DSM diagnosis. This has serious implications for client care and billing and for other mental health professionals in Texas who do not have a license to practice medicine and who may be targeted next by TMA.

An interesting side note:  The two justices in the majority deciding the case both listed TMA as supporters of their election campaigns in 2012.


Provided by trusted attorney Tom Hartsell and CPH and Associates, your leading provider for professional liability insurance for mental health practitioners.

Oct 06

Age of Consent for Mental Health Treatment in the State of Georgia

Age of consent for mental health treatment Georgia

Age of consent for mental health treatment Georgia

In general, Georgia law provides that the age of majority is 18 years, and every person under 18 is a minor, according to O.C.G.A. Section 19-7-2.  According to this Statute, minors are not competent to consent to treatment by a mental health professional, and that parents must consent to treatment for their minor children who are under the age of 18.

There are, however, several basic exceptions to this general rule.  Those exceptions are as follows:

1.            Minor parents: minors who are parents may consent to treatment for their children;

2.            Drug abuse:  minors may consent to treatment for drug abuse;

3.            Emancipated minors:  An emancipated minor is one who is living independently and supporting him/herself, and living independent of a parent;

4.            Reproductive issues:  Under Georgia law, any female may give consent for treatment, regardless of her age, for treatment related to pregnancy, birth control, or child birth; and

5.            Venereal disease:  A minor in the State of Georgia who has contracted an STD may give consent to treatment for the condition, regardless of age.

When parents consent to mental health treatment for their minor children, parents should agree, in writing if possible, to allow the therapist to create a safe place for counseling, where parents will not intrude.  In discussing the need for privacy between a therapist and a minor client, parents may be informed by the therapist that they will be told of any need for referrals for additional services; and that the therapist will advise the parents regarding any situations which they need to know about.  In addition, the therapist will also inform parents regarding what they can do to assist their child.

Information provided by Attorney Dennis Lane

Sep 29

Your Patient has Harmed Themselves. Are You Covered?

Young Female Patient Talking To Nurse In Emergency Room

As an experienced mental health professional, you know better than anyone that people can be unpredictable. This includes patients. As a professional, you might feel that there’s a need to hold your patient’s hand to keep them on the right path. However, no matter how much you support them in creating a healthy life, it’s possible that your patient may steer away from this path toward a crisis.

This is par for the course in the mental health field, but the truth doesn’t make it any easier to deal with or undo the unexpected tragedies of your patients.

As much as you might try, you are affected by your patients and their actions. It’s why the rate of depression affecting therapists is so high: 61% percent.

When your patient who has been in your care and has trusted your advice harms themselves, are you liable? It’s a question that, although difficult to fathom, is very necessary to ask and prepare for. It’s not enough to have group or employment coverage, because, many times, the patient goes after their caregiver.

What happens when a patient attempts to sue you? The first thing you can expect is the damage that occurs to your reputation by mere association. There are also potential fees that you may have to pay out of your own pocket, if you’re not covered. We’ve read the horror stories that plague the medical industry, your patient, referred to you for mental health care, puts you in an even more vulnerable position, especially if they can’t be trusted to care for themselves…it’s why they’ve entrusted you in the first place.

Some attorneys even specialize in the area of helping the loved ones of patients who have committed suicide to receive retribution, at the expense of the treating professional. All you have to do is Google the statistics and it’s enough to make you want to close your doors. When you’re done looking up the alarming facts, you’ll likely agree it’s more important than ever to secure liability insurance, in case one of your patients becomes unstable. We’re here to help you protect yourself, your career, and your assets.

With the peace of mind that comes with having coverage, you can be that much more of an effective healer for your patients. It’s why you’ve chosen therapy: to derail these tragedies and to save people’s lives. To make a difference.

Sep 28

Responding to Requests for Children’s Treatment Records

Child psychologist with a little girl, a child draws

Special care should be taken by therapists when a child is receiving counseling services, and the child’s parent requests a copy of all treatment notes and records. If possible, comply with the parent’s request by providing a treatment summary or progress report in response, in order to protect the child’s confidences made to the therapist.  Children, like all clients, are asked to confide their problems to therapists, and are assured that the information will remain confidential.

Children often confide in therapy very personal feelings, such as “I do not want to live with my dad.  He is mean to me.” Or they may confide, “I do not like my mom’s new boyfriend.” When parents access treatment notes containing such statements, foreseeable harm to the child, who has confided these feelings, results. The parent may berate the child for making statements, in confidence, in the safety of a counseling session, which the parent finds offensive.  Furthermore, when a child realizes that confidences regarding emotions, feelings, or parent-child problems, confided to a therapist, are being disclosed to the child’s parent, the child learns that information provided to the therapist is not kept in confidence and may be shared with parents. This, of course, tends to destroy a child’s trust in the counseling process.

When parents are involved in a divorce or custody case, and a request is made for a child’s mental health treatment records, that parent may not have the child’s best interests in mind. The New Hampshire Supreme Court issued a landmark precedent in Berg v Berg, 886 A.2d 990 (N.H. 2005). In its decision, the Court ruled that either a G.A.L. or the Judge should make a determination concerning whether it is in the best interests of a child, whose treatment notes have been requested by a parent, for treatment notes to be provided to the parents, or not. The Court’s decision stated that judges cannot presume that parents have their children’s best interests at heart, when children’s mental health treatment records are sought for use in divorce or custody litigation.

In order to avoid conflict with a parent who demands all of the therapist’s treatment notes and records, when the individual receives a copy of a treatment summary or progress report, it is an excellent practice to disclose to the parent in the treatment contract or in a disclosure statement that the therapist will comply with the parent’s request for treatment records by providing a treatment summary or progress report.

By Denis Lane, Attorney at Law

Sep 22

What You Can Learn From Healthcare Workers Without Insurance

Doctors and patients in hospital waiting room.

Flammable patients? Have you heard of such an incident happening in the operating room? But it’s true. Each year an estimated 650 people are victims of surgical fires during surgery. Some of the causes seem like circumstances straight out of fiction: an electronic scalpel meets the oxygen supply; an alcohol-based disinfectant interacts with a cauterizing tool.

No one can argue successfully that the patients aren’t the ones suffering the most. When people lose their lives and limbs, nothing could be worse. Medical staff often suffer psychological issues after a patient tragedy, and medical errors take place more frequently than most people might think.

One healthcare worker only inserted an IV needle into a car crash victim’s arm in an effort to save her life. When the patient succumbed to her injuries, the man attempting to rescue her became one of many called to defend himself in a suit brought by the victim’s surviving family members.

Health care specialists endure a multitude of injustices when sued, and the implications are far-reaching. Many stand to lose their careers, the very reason they might feel they exist. When that lifelong mission to help people is disrupted, when doubt is placed on their expertise and competency, many medical specialists develop anxiety, depression, and may even begin to question their skills. The last thing any treating professional needs to think about is whether or not the verdict will also clean them out financially.

Living reactively is pretty exhausting. We hope you will consider letting us help you prepare for your future.

Sep 03

Human Errors Happen in Healthcare More Often Than You Think

Medicine doctor's working place. Focus on stethoscope, doctor's hands typing something on background. Healthcare and medical concept. Copyspace

Your coworker shows up hung over. No crime… They’re not legally drunk. You both laugh about her adventure from the night before and go about your day. She’s merely tired you tell yourself.

Your favorite dietician you adore working with was up all night with her newborn son. She rubs her eyes as she blearily grabs the chart of the first patient lined up in the examination room.

Another one of the therapists you regularly interact with is going through a divorce. You admire her resolve to stay professional and keep it together, although she does seem distracted at various times throughout the day.

Overall, you feel pretty good about the crew you work with, and while you hate to think about the possibilities of what could go wrong, you know you work for a reputable company and they have insurance for a reason. You’re covered, you think, even if something goes wrong. And nothing will, the mantra plays in your head throughout the day and makes you feel better.

You reason you’re not responsible for another person’s actions anyway. You’re not their manager.

Much in the same way you would stop one of your friends from driving while buzzed, or drunk, you actually are responsible. If you are aware there are issues with a coworker who seems to be struggling, and who might have made minor errors throughout the day, you need to report it. Even if the two of you are friendly, you still must speak up so a more grievous mistake can be avoided. But how many people really ring the alarm? How many people choose instead to ignore risky situations, hoping nothing terrible happens?

Forget about being tired, hung over, stressed, or sick. What about the percentage of human error? It happens. You’ve made a mistake. We’ve all made mistakes. We’re not robots after all. And it is highly likely in the event of a mishap you were witness to that you would be seen as a party who contributed.
You can remove your part of the risk when you have the appropriate coverage. Then all that’s left to do is the right thing. You’ve removed the worry about how a wrong turn in the course of taking care of a patient can affect you.

Jul 08

Preventing a False Malpractice Claim

middle aged male therapist consulting female patient in office

Many times in a mental health, we as professionals experience encounters with patients who perceived slights against them when in reality, there is no real threats to fear. Whether due to an inability to properly comprehend reality, or done intentionally to cause a problem, there are many documented cases of patients who file a regulatory claim against their mental or allied health care provider which does not hold water. That said, even a false malpractice claim can smear one’s professional reputation, cause a loss of trust in clients and staff, and cost a provider thousands in legal expenses to clear up.
The good news is that if a provider carries the proper liability insurance coverage, they’re likely protected, even if the claimant receives an ill-gained settlement for legal expenses. In reality, once a claim has been filed, the ability to control its course is out of your hands as a professional, and so, the advice offered here will center on preventing these claims from occurring, and how to secure proper protection for your practice.


Prevention of False Claims


Being able to prove innocence once a false malpractice claim is filed can be very difficult, if not impossible, while preventing the problem is measurably simpler and more effective. Steps for avoiding the liability nightmare of a false claim include:

  • Documentation of intentions, as a privacy agreement/patient agreement, which can be prepared internally or written by an attorney, can help to avoid a patient who claims they are being charged for services which were not provided, or that they were not informed of costs, service limitations, and confidentiality requirements from the start.
  • Keep on documenting! Every interaction with a client could prove to be important to the eventuality of a malpractice claim, should one be filed. Having accurate visit notes, including notations of any accusatory or suspicious behavior, payment compliance issues, failure to fill or take prescriptions, or threats can prove invaluable during the claim process.
  • Manage patient expectations by remaining honest and upfront with clients about their situation without giving false promises when the professional isn’t sure they can fix the problem they’re facing.
  • Know when to back off, because sometimes, a client is simply too sensitive to receive further constructive criticism. Perceived slight is enough to cause some problem clients to desire revenge by way of false accusation.
  • Notify a client when there is a problem of any kind, and document the conversation in the patient’s visit notes. If  it is necessary, report the patient using the local resources and alert emergency medical personnel if they display behaviors that concern the safety of himself or another person.

Aside from these basic avoidance, little can be done if an irrational or irate client decides to file a false claim against a mental health professional.The best way to face a malpractice claim is to remain calm, never becoming aggressive or angry with the patient. Insurance is the best way to protect a mental health professional from a malpractice claim, and following these simple steps may help to prevent the problem from escalating may help to avoid the claim being filed in the first place. CPH & Associates offers guidance about the types of coverage needed by all mental and allied health professionals. You can get more information on the services they offer this industry here.

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