It seems like the “ethical issue” is her own feelings on the treatment. I don’t think it has to do with your state of mind. I do know that some insurance will only cover telehealth with a provider in the same state, but I don’t think that’s an ethics issue. Either way, I’d try looking for someone else. Which I know is easier said than done!
It was leaned on pretty heavily as an excuse. From the initial appointment (assessment) all of this was knowledge available for her prior to my first appointment but I should be smart enough to know that no one reads the intake paperwork.
I’ve canceled all future services with her. You’re right about everything especially finding the right one.
Thank you for being sympathetic.
This seems suspicious to me, particularly as she went on to express an opinion on a treatment she herself is uneducated about (aside from what you told her, I mean in a sense of looking through studies on efficacy and safety on her own time). I’ve had therapy sessions after Spravato with no issues whatsoever. However, I don’t have experience with seeing mental health providers in a different state, so I’m unsure if that’s related to her concerns or not. Regardless, I think her response was ridiculous. I’m sorry she was dismissive about your treatment - you deserve better.
My therapist intentionally schedule a session after by third appointment as he wanted to see if it worked better for me. We didn’t continue cause of timing now but it helped him understand how I react to the treatment.
Chiming in as a Spravato user and soon to be therapist.
I think we all can agree that it would be great if she had more knowledge around what Spravato is and how much it can benefit clients. Hopefully she takes some time to learn more about it before your next session.
I don't know this for sure, but my guess is that she's worried about conducting treatment with a client in an "substance-induced altered mental state". This likely varies a bit by each state, but generally it's considered unethical to conduct a session with someone under the influence of drugs or alcohol. There *is* such a thing as ketamine-assisted therapy (so a therapy session that takes place with the client under the influence of ketamine), but that's not legal everywhere and is definitely newer to the field (with lots of haters). Conducting KAT requires a bunch of different safety protocols and liability insurance, so it's possible she was trying not to put her license at risk by practicing outside her area of expertise. Not to mention KAT is almost always done in-person.
Long story short, I kind of understand her mindset, but it was likely misguided. You're well within your right to find a new therapist if this no longer feels like a good fit. Good luck!
We had a policy at the community mental health agency I worked at where if our client admitted to being intoxicated in any way or was clearly drunk or high during the appointment we had to end the appointment immediately. I think some of it was liability, but I assumed that was just because of unpredictable behavior and often being in a one-on-one setting, but I could see how there would be ethical implications with certain drugs.
Honestly though, her reaction remind me of how the psychiatrist I used to see reacted when he found out I was prescribed medical marijuana for chronic pain. He was clearly not happy about it and was asking me about what proof they have that it’s even safe. I didn’t understand how it’s my problem that he hasn’t researched it himself… he wound up being so critical of it, and like you, I was considering finding someone new already. The new psychiatrist is fine with me managing pain with a prescribed substance and is the one prescribing the Spravato. Feeling judge by a mental health provider is not worth it, so I’d recommend finding someone new.
Yes, it’s considered unethical and inappropriate to provide therapy if someone is currently intoxicated with alcohol or marijuana but that is really only if they are drunk or high during the session time. Since Spravato is medically prescribed it’s more likely to fall under the categories of say ADHD medication or daily opioids for someone with bulging discs in their back for example. It’s still a bit of a gray area because it’s so new, a lot of the state boards who grant clinical licensure haven’t developed specific policies on therapy with spravato yet. So, it’s down to the clinics to set their own policies. Licensure for clinics to actually prescribe spravato is all on the medical side and managed by different entities than mental health practitioners are.
As far as I know it’s up to provider discretion, a supervised Spravato administration several hours before is far different from someone showing up at your office right after a recreational journey down a K-hole. Same for someone who uses topicals with Cannabis in them versus someone who inhales or ingests Cannabis and is actively high from the psychoactive properties. Topicals do not get you “high.”
If she lives in a different state in the US than you do then it’s not legal for her to practice therapy with you. Clinical licensure is granted by the state and is only valid for the state you’re licensed in. In California that requires a license through the Board of Behavioral Sciences. You have to have a different type of license and supervision while working on your full licensure (which takes 3000 hours). Each state has their own process but they’re fairly similar.
The patient needs to live in that state. If the patient is on a business trip or vacation it’s a bit of a gray area but still dicey.
As for her speaking after spravato with you, no that’s not a liability for her because she didn’t prescribe the spravato. Only a medical practitioner can prescribe it and licensed clinics can administer it. Ketamine is a bit different right now since it’s not technically FDA approved for mental health and is being used off label for that purpose, but again, requires a medical prescription. I’m not sure about doing therapy actively during the session with a therapist who doesn’t work for or in concert with the clinic, but hours later wouldn’t be an issue as far as I know.
Not unless you were a brand new patient just being read exclusions to confidentiality and signing paperwork. It may be that she was concerned because you hadn’t discussed and agreed to do the therapy before you took the spravato. Which is understandable. She may not be comfortable providing therapy the day of treatment, especially if she isn’t fully licensed yet or works with an agency that hasn’t approved their clinicians to do that.
I had mental health therapy at a residential during spravato administration but they only did 56mg there. It was a bit weird because there was a nurse and a clinician in the room with me the whole time. I do know some providers don’t like to do patient visits on the same day as another Psychiatric service because of concerns about double billing with insurance. Like if I’m doing a Partial Hospitalization Program, for example M-F, my regular therapist would only be willing to see me on Saturdays.
So, my guess it’s a mixture of things your clinician is worried about.
-I was a Clinical Social Worker in California before I had to abandon my licensure process 2000 hours in and go on disability.
It seems like the “ethical issue” is her own feelings on the treatment. I don’t think it has to do with your state of mind. I do know that some insurance will only cover telehealth with a provider in the same state, but I don’t think that’s an ethics issue. Either way, I’d try looking for someone else. Which I know is easier said than done!
It was leaned on pretty heavily as an excuse. From the initial appointment (assessment) all of this was knowledge available for her prior to my first appointment but I should be smart enough to know that no one reads the intake paperwork. I’ve canceled all future services with her. You’re right about everything especially finding the right one. Thank you for being sympathetic.
I have my second Spravato session tomorrow. We need to look out for each other. Good luck!
I agree-it took me several therapists to find one I really can work with and I feel like she actually cares.
This seems suspicious to me, particularly as she went on to express an opinion on a treatment she herself is uneducated about (aside from what you told her, I mean in a sense of looking through studies on efficacy and safety on her own time). I’ve had therapy sessions after Spravato with no issues whatsoever. However, I don’t have experience with seeing mental health providers in a different state, so I’m unsure if that’s related to her concerns or not. Regardless, I think her response was ridiculous. I’m sorry she was dismissive about your treatment - you deserve better.
My therapist intentionally schedule a session after by third appointment as he wanted to see if it worked better for me. We didn’t continue cause of timing now but it helped him understand how I react to the treatment.
Good initiative on your therapist’s part! I’m glad he displayed care in the ways Spravato may affect you individually!
Chiming in as a Spravato user and soon to be therapist. I think we all can agree that it would be great if she had more knowledge around what Spravato is and how much it can benefit clients. Hopefully she takes some time to learn more about it before your next session. I don't know this for sure, but my guess is that she's worried about conducting treatment with a client in an "substance-induced altered mental state". This likely varies a bit by each state, but generally it's considered unethical to conduct a session with someone under the influence of drugs or alcohol. There *is* such a thing as ketamine-assisted therapy (so a therapy session that takes place with the client under the influence of ketamine), but that's not legal everywhere and is definitely newer to the field (with lots of haters). Conducting KAT requires a bunch of different safety protocols and liability insurance, so it's possible she was trying not to put her license at risk by practicing outside her area of expertise. Not to mention KAT is almost always done in-person. Long story short, I kind of understand her mindset, but it was likely misguided. You're well within your right to find a new therapist if this no longer feels like a good fit. Good luck!
So it’s essentially a judgement call? That’s such a slippery slope. Candor shouldn’t be discouraged. Now I know. Thank you. 😊
We had a policy at the community mental health agency I worked at where if our client admitted to being intoxicated in any way or was clearly drunk or high during the appointment we had to end the appointment immediately. I think some of it was liability, but I assumed that was just because of unpredictable behavior and often being in a one-on-one setting, but I could see how there would be ethical implications with certain drugs. Honestly though, her reaction remind me of how the psychiatrist I used to see reacted when he found out I was prescribed medical marijuana for chronic pain. He was clearly not happy about it and was asking me about what proof they have that it’s even safe. I didn’t understand how it’s my problem that he hasn’t researched it himself… he wound up being so critical of it, and like you, I was considering finding someone new already. The new psychiatrist is fine with me managing pain with a prescribed substance and is the one prescribing the Spravato. Feeling judge by a mental health provider is not worth it, so I’d recommend finding someone new.
Yes, it’s considered unethical and inappropriate to provide therapy if someone is currently intoxicated with alcohol or marijuana but that is really only if they are drunk or high during the session time. Since Spravato is medically prescribed it’s more likely to fall under the categories of say ADHD medication or daily opioids for someone with bulging discs in their back for example. It’s still a bit of a gray area because it’s so new, a lot of the state boards who grant clinical licensure haven’t developed specific policies on therapy with spravato yet. So, it’s down to the clinics to set their own policies. Licensure for clinics to actually prescribe spravato is all on the medical side and managed by different entities than mental health practitioners are. As far as I know it’s up to provider discretion, a supervised Spravato administration several hours before is far different from someone showing up at your office right after a recreational journey down a K-hole. Same for someone who uses topicals with Cannabis in them versus someone who inhales or ingests Cannabis and is actively high from the psychoactive properties. Topicals do not get you “high.”
If she lives in a different state in the US than you do then it’s not legal for her to practice therapy with you. Clinical licensure is granted by the state and is only valid for the state you’re licensed in. In California that requires a license through the Board of Behavioral Sciences. You have to have a different type of license and supervision while working on your full licensure (which takes 3000 hours). Each state has their own process but they’re fairly similar. The patient needs to live in that state. If the patient is on a business trip or vacation it’s a bit of a gray area but still dicey. As for her speaking after spravato with you, no that’s not a liability for her because she didn’t prescribe the spravato. Only a medical practitioner can prescribe it and licensed clinics can administer it. Ketamine is a bit different right now since it’s not technically FDA approved for mental health and is being used off label for that purpose, but again, requires a medical prescription. I’m not sure about doing therapy actively during the session with a therapist who doesn’t work for or in concert with the clinic, but hours later wouldn’t be an issue as far as I know. Not unless you were a brand new patient just being read exclusions to confidentiality and signing paperwork. It may be that she was concerned because you hadn’t discussed and agreed to do the therapy before you took the spravato. Which is understandable. She may not be comfortable providing therapy the day of treatment, especially if she isn’t fully licensed yet or works with an agency that hasn’t approved their clinicians to do that. I had mental health therapy at a residential during spravato administration but they only did 56mg there. It was a bit weird because there was a nurse and a clinician in the room with me the whole time. I do know some providers don’t like to do patient visits on the same day as another Psychiatric service because of concerns about double billing with insurance. Like if I’m doing a Partial Hospitalization Program, for example M-F, my regular therapist would only be willing to see me on Saturdays. So, my guess it’s a mixture of things your clinician is worried about. -I was a Clinical Social Worker in California before I had to abandon my licensure process 2000 hours in and go on disability.