Malpractice in clinical social work: A perspective on civil liability in the 1980's

Recently reported cases involving the malpractice of psychiatrists have also focused attention on the potential liability for similar acts by clinical social workers. While there is no appellate case authority holding social work clinicians liable for malpractice at this time, the potential for such litigation is enormous. This article explores some of the more common areas of concern and suggests several prophylactic measures that clinicians may employ to safeguard both their professional career and their continued financial independence.     

Psychic functions of failure

While we can explain significant differences in social mobility between different occupational categories in terms of the economic and social resources made available to them, in order to understand those who deviate from the statistical mode we need to look at the unconscious meaning of "success" and "failure." Beatrice, Dave, and Sally are all children of professional families and yet have great difficulty being successful at work. Their difficulties with work are multi-determined and there are oedipal and preoedipal issues involved. However, in the case of Beatrice the issues are predominantly oedipal, while in the other cases the issues are primarily preoedipal. It seems that while the common oedipal themes inhibiting productive work and work satisfaction have been discussed in psychoanalytic literature under the rubric "work inhibition," albeit to a small extent, the preoedipal themes have been given less attention. This is because the traditional concept of "inhibition" has taken such a central place in the psychoanalytic perspective on work. The concept of "work inhibition" has paralyzed the development of a broader psychoanalytic framework for the analysis of work problems. As long as we limit our discussions of problems with work to the term "inhibition," they will focus on the oedipal problems of neurotic patients and a large gap will remain between theory and clinical experience because a large number of our patients have difficulties with work that are rooted in preoedipal issues. Unless we can stop being "inhibited" by the very concept, our theoretical understanding of problems with work will continue to lag behind our clinical understanding. "Work inhibition" is not the only type of major problem with work patients can have--they can be the result of a variety of dynamics on either oedipal or preoedipal levels.     

Cognitive Models of Depression: The State of the Notion

This article describes a program of research on excessive reassurance-seeking and its relation to depression. Relevant theory, central predictions, and empirical work are summarized, and the research program's implications for depression science and clinical work are noted. We argue that excessive reassurance-seeking (a) is implicated as a potential contributory cause of depressive symptoms; (b) is involved in generating negative interpersonal outcomes, such as interpersonal disruptions and "contagious" depression; (c) relates to other theoretically important depression-related constructs in ways that may broaden and enhance depression theory and science; and (d) has potential import for the treatment and prevention of depression. The article may be of interest to those studying the social and clinical psychology of depression, as well as those engaged in the psychotherapy of depressed people, and may inspire future theoretical, empirical, and clinical work, with the ultimate aim of increasing understanding of and decreasing suffering from depression, a vexing (and increasing) human problem.     

Support systems of elders in rural communities

The social network concept can be used to guide the extension of the mental health clinician's role to the practice of prevention on the local level. A model of such work is described which builds on clinical skills in collaborative consultation with formal and informal social support networks in a community. The model is illustrated and expanded through a case example of a project in a rural New England town to address issues of stress and support for frail elders. Focusing on the social network of such elders, consultations were developed to address the needs of middle generation caregivers, natural helpers, organized community associations, general community attitudes toward aging, and the ability of the community to secure and use outside resources. Issues of community entry through natural sponsorship are reviewed and the overall process of community empowerment is emphasized as a guiding principle in work with social networks.     

Attitudes Toward Private Practice in Social Work:

This article, based upon a study examining attitudes of social workers toward private practice, describes social work educators and nonprivate clinical social workers as having some inaccurate perceptions of the private practitioner. Private practitioners do want to remain identified with social work although they are frequently dissatisfied with the profession. Findings are also described which reveal a "tension" all social workers may feel in their attempt to integrate personal goals with professional values and beliefs.     

美国医师的职责

在此讨论的主要问题是,什么样的社会力量能使医师对诊治病人和技术操作的质量担负起责任？这种社会力量的来源之一是职业理念;另一种约束力来自于正规社会机构的直接管理,相关权限的依据是国家和地区规范医院和医师行为的法律。第三种规范的形式和政府司法部门紧密相关,它在很大程度上是一种间接性的约束力,涉及病人因医疗事故对医生及其投保的责任保险公司所进行的索赔和诉讼。强调了第三种力量,并突出了在医师和医疗行业圈之外的社会力量对医疗活动的指导作用。     

Understanding Transference and Countertransference

Abstract

Professional misconduct-especially misconduct involving client-worker boundary violationsgenerates serious costs for clinical social workers. It harms the very clients we aim to help; it frequently tarnishes the reputation of not only the individual social worker involved but also the face of the entire profession; and, it adds significantly to the overall costs of malpractice insurance. This paper defines the scope of the problem and provides support for understanding transference and countertransference as important contributors to prevention.     

Training and credentialing in forensic psychiatry

The increase in legal regulation of psychiatric practice, malpractice litigation, number of mentally ill in correctional settings and concerns about the sometimes embarrassing quality of expert witness testimony has led to an heightened focus on training and credentialing of psychiatrists who work in these areas. The past 20 years has witnessed a growth of professional organizations, journals, accredited training programs and board certification. The paper outlines the nature of these programs and some of the dilemmas for the profession in establishing formal subspecialties.     

采用人性化护理管理降低护理差错的思考

随着社会的迅速发展及人们生活水平的不断提高,人们对医疗服务的需求增加,护理工作者所面对的压力增大,产生护理差错的概率增加。同时,护理工作者知识结构水平的改变,整体素质上升,对护理管理要求提高,人性化管理成为当今谈论的焦点,也成为减少护理差错、提高护理质量的重要手段。     

Delinquency prevention through training parents in family management

Nearly two decades of clinical research at the Oregon Social Learning Center (OSLC) have helped to shape a theory of antisocial behavior in boys. Models depicting the theory are presented and discussed. In addition, family management variables such as "discipline," "monitoring," "positive parenting," and "problem solving" are described as used in clinical applications. Total aversive behavior (TAB), based on home observations, and parent daily report (PDR), based on telephone interviews, are examined as outcome indicators for a variety of studies investigating the efficacy of the OSLC social interactional therapy. Several recent reports of treatment for adjudicated adolescents and their families are included; law violations are the dependent measures in those studies. Examples of the interface between clinical work and theory at OSLC are presented. Questions of generalization of the clinical methodology to large urban populations, and access to parents who most need to learn the parenting techniques are noted.     

Teleconferencing model for forensic consultation, court testimony, and continuing education

A medical center-based forensic clinic that provides the necessary comprehensive consultation, continuing education, court testimony, and clinical services through an applied model of teleconferencing applications is addressed. Telemedicine technology and services have gained the attention of both legal and clinical practitioners, examining trends and models of health care for underserved populations, and identifying where consultation with a team of professionals may benefit service providers in rural communities. The contribution offered herein provides an understanding of the history of the development of the clinic, a theoretical model that has been applied to a clinical forensic program that employs telepsychiatry services, and the ethical and malpractice liability issues confronted in using teleconferencing services. This model is examined through a child and adolescent forensic evaluation clinic. The goals of this model are offered, as are a number of applications within the broad spectrum of services utilizing telemedicine. Finally, changing patterns are addressed in clinically based health-care delivery for criminal justice, social services, and forensic mental health.     

A Review of “The Relational Origins of Prejudice: A Convergence of Psychoanalytic and Social Cognitive Perspectives”

Abstract

Key concepts in social welfare and clinical social work - concepts such as person-in-environment, women's rights, prevention and outreach-had as precedents the pioneering theory and practice of Europe's free psychoanalytic clinics of the 1920s. Sex-Pol, a Viennese community-based clinical network created in 1927 by Wilhelm Reich, perhaps the most overtly political of the first psychoanalysts, was motivated by reformist social goals he shared with Sigmund Freud. This historical study of Sex-Pol draws on Reich's own words to explore his use of the term “social work” where clinical work is predicated on an activist ideology of human liberation.     

Medical malpractice and the legal standard of care

In this essay, I examine the relationship between lawsuits for medical malpractice and the legal standard of care. I suggest that there is an insidious, dynamic relationship between physicians' reactions to the recent increase in malpractice litigation and an artificial elevation of the legal standard of care. Since, that is, the legal standard for proper medical care is based upon the community standard of care rather than the reasonable person standard, to the extent that overtreatment or “defensive” medicine becomes widespread as a reaction to malpractice litigation, the legal standard becomes elevated as well. Thus, it will increasingly be the case that unless a physician practices defensive medicine, and hence practices unreasonably, she risks being found liable for medical malpractice.     

Finding our way in perplexity: the meanings of sex in the analysis of a gay man.

As preconceptions about the meaning of sexual orientation are increasingly abandoned, analysts are left with the question of how these matters are to be addressed in clinical work. These problems are explored as they emerged in analytic work between a "gay" man and a "straight" analyst. Emphasis is placed on how the search for personal meaning is impacted by the intellectual and social context inhabited by analyst and patient.     

Working with “Difficult” Patients: An Interview with Jorge García Badaracco

Jorge García Badaracco's pioneering work is well-known in his native Argentina, but not so much elsewhere. Since he was appointed as Director of a service in the Borda Buenos Aires Neuro-Psychiatric Hospital in 1959, García Badaracco started to make use of all available resources to overcome the many problems that the analysis of "difficult patients" (often psychotic) entails. In later years, he developed his ground-breaking "multifamily groups", that is, therapeutic groups that included patients, their relatives, nurses, members of the staff, and that offered the possibility to work simultaneously, in one single therapeutic intervention, on the individual, familiar, and social dimension of the mind. In this interview with García Badaracco, Francesca Viola Borgogno introduces the reader to this distinguished figure, as well as to some of his most original theoretical and clinical concepts, such as "the maddening object", "the pathological and pathogenic interdependence", "the healthy virtuality", and so on.     

Social Media in Disaster Risk Reduction and Crisis Management

This paper reviews the actual and potential use of social media in emergency, disaster and crisis situations. This is a field that has generated intense interest. It is characterised by a burgeoning but small and very recent literature. In the emergencies field, social media (blogs, messaging, sites such as Facebook, wikis and so on) are used in seven different ways: listening to public debate, monitoring situations, extending emergency response and management, crowd-sourcing and collaborative development, creating social cohesion, furthering causes (including charitable donation) and enhancing research. Appreciation of the positive side of social media is balanced by their potential for negative developments, such as disseminating rumours, undermining authority and promoting terrorist acts. This leads to an examination of the ethics of social media usage in crisis situations. Despite some clearly identifiable risks, for example regarding the violation of privacy, it appears that public consensus on ethics will tend to override unscrupulous attempts to subvert the media. Moreover, social media are a robust means of exposing corruption and malpractice. In synthesis, the widespread adoption and use of social media by members of the public throughout the world heralds a new age in which it is imperative that emergency managers adapt their working practices to the challenge and potential of this development. At the same time, they must heed the ethical warnings and ensure that social media are not abused or misused when crises and emergencies occur.     

Case Presentation—A Perfect Transference

This is the third in a series of reports on the "dual professional identity" of the social work-psychoanalyst based on findings from the "MPI" Project, an empirical study conducted at a large psychoanalytic training institute. The MPI study was designed to answer two questions: Do social work-psychoanalysts demonstrate the attributes of membership in the social work profession? Are social work-psychoanalysts distinguishable from their fellow psychoanalysts in psychology? The theoretical orientations of the social work- and psychologist-psychoanalysts in the MPI sample were investigated utilizing both self-reports of preferred theoretical schools and a structured research instrument, the "Theoretical Orientation Questionnaire." With one exception, no statistically significant differences between the two disciplines were observed. The relevance of these findings to the claim promulgated by leaders in clinical social work that social workers practice a uniquely orientated psychotherapy is discussed.     

Documenting suicide risk assessments and proportionate clinical actions to improve patient safety and mitigate legal risk

Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw from our combined decades of multidisciplinary experience as a clinical psychologist, forensic psychiatrist, medical malpractice attorney, and clinical psychology trainee to discuss the documentation of suicide risk assessment and management as a conduit to patient safety and legal risk mitigation. We additionally highlight documentation as a core clinical competency across disciplines and note areas of improvement, such as increased training, to bolster documentation practices.     

中美医疗责任保险之比较研究

医疗责任保险是转移损害、分散风险的有效方法之一.为促进我国医疗责任保险的发展,对中美医疗责任保险的市场主体、产品供给、运营环境、运作实践和医界的保险意识进行比较分析,借鉴美国的先进经验,从社会系统工程的角度提出我国医疗责任发展对策.