Termination of Treatment

June 2005

… Here’s a common situation that often creates a dilemma for therapists. Suppose you are treating a minor, eleven years of age, with the consent of both parents. The court had ordered joint legal custody and the court order specifies that: “the consent of both parents shall be necessary in order to make any decisions with respect to the rendering of health care, whether physical or mental, to the minor.” Prior to the commencement of treatment, you obtain the consent to treat from both parents, complying with whatever the requirements are for documenting such approval. Three months later, one of the joint custodians calls the therapist and says that he withdraws his consent. He demands that the therapy end. The other joint custodian wants treatment to continue. Must the therapist comply with the request to end or terminate therapy?

This is not an easy issue to resolve, and a proper resolution will depend upon the interpretations and nuances of state law. Here’s what I have successfully argued in several cases over the years: The therapist had the permission of both parents to treat, as per the court order. Now, one of the parents is in essence asking the therapist to terminate treatment. The therapist, however, has determined that the minor needs continued treatment. The therapist does not want to abandon the patient, and since the therapist does not have both joint custodians agreeing to a termination of treatment (e.g., the mother wants her child to get continued care and believes that the father is acting in bad faith and in his own selfish interests) as the court order appears to require, the therapist properly continued to see the child in therapy. The consent to treat was given at the beginning and cannot be “taken back.” Now the issue is not consent to treat, but rather, termination.

Caution – whether or not the above line of reasoning or argument will work for you in your state and with your license, is a matter that must be carefully examined. The answer will depend upon the applicable state law or regulation and the wording of the court order, which may be ambiguous.


Richard Leslie

"At the Intersection of Law and Psychotherapy" Richard S. Leslie is an attorney who has practiced at the intersection of law and psychotherapy for the past twenty-five years. Most recently, he was a consultant to the American Association for Marriage and Family Therapy (AAMFT), where he worked with their various state divisions to develop and implement their legislative agendas. He also provided telephone consultation services to AAMFT members regarding legal and ethical issues confronting practitioners of diverse licensure nationwide. Additionally, he wrote articles regarding legal and ethical issues for their Family Therapy Magazine and presented at workshops on a variety of legal issues. Prior to his work with AAMFT, Richard was Legal Counsel to the California Association of Marriage and Family Therapists (CAMFT) for approximately twenty-two years. He was director of Government Relations for CAMFT, and as such was the architect of CAMFT’s widely regarded and successful legislative agenda. He represented CAMFT before the regulatory board (the Board of Behavioral Sciences) and was a tireless advocate for due process and fairness for licensees and applicants. He was a regular presenter at workshops and was consistently evaluated as CAMFT’s most highly rated presenter. He also sat with the CAMFT Ethics Committee and acted as their advisor on matters pertaining to the enforcement of ethical standards. Richard is an acknowledged expert on matters pertaining to the interrelationship between law and the practice of marriage and family therapy and psychotherapy. For many years, he taught Law and Ethics courses for a number of colleges and universities in their marriage and family therapy degree programs. While at CAMFT, he provided telephone consultation services with thousands of therapists in California and elsewhere for over twenty years. He is highly regarded for his judgment, his expertise, his direct style, and his clarity. Richard has been the driving force for many of the changes and additions to the laws of the State of California that affect MFTs. In 1980, he was primarily responsible for achieving passage of the "Freedom of Choice Law" that required insurance companies to pay for psychotherapy services performed by MFTs. Passage of that law allowed MFTs to earn a living, allowed them to better compete in the marketplace, and strengthened the profession in California by leading to a great increase in the number of licensees and CAMFT membership. Currently, about half of the licensed marriage and family therapists in the country are licensed in California. While at CAMFT, Richard was primarily responsible for, among other things, the successful effort to criminalize sex between a patient and a therapist. He was successful in extending the laws of psychotherapist-patient privilege to MFTs, thereby giving patients the same level of privacy protection as when seeing a psychiatrist or psychologist. He fought tirelessly and successfully for the right of MFTs to refer to themselves as "psychotherapists," to perform psychological testing services, to be appropriately reimbursed by California’s Victims of Crime Program, and to be employed in county mental health agencies throughout California. Richard was admitted to the Bar in New York (1969) and in California (1973). While practicing in New York, he served as a public defender, and later, as an Assistant District Attorney. Shortly after moving to California, he worked for the San Diego County Human Relations Commission as their Law and Justice Officer. While there, he worked successfully to achieve greater racial diversity in the criminal jury selection system and to expose and stop police abuse. For such work with that agency, he was the recipient of the Civil Libertarian of the Year Award by the San Diego Chapter of the American Civil Liberties Union.

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