Barter With a Patient

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Avoiding Liability Bulletin – June 2005

… What about barter with a patient – is it legal? Is it ethical? The answer depends. Therapists must first be aware of individual state law and regulation to see whether or not the state has taken a public policy position on this issue. If so, the law should of course be followed. If the state has remained silent on the issue, one should determine how the ethical standards for his or her profession address this issue.

One professional association’s ethical standards provide that marriage and family therapists “ordinarily refrain” from accepting goods, services, or other non-monetary remuneration from patients in return for professional services. Another professional association for MFTs takes a more specific approach by saying, in part, that bartering for professional services may be conducted only if the client requests it, the relationship is not exploitative, and the professional relationship is not distorted. That association’s ethical standards additionally require that a clear written contract be entered into between the therapist and patient.

Be careful. This is an area where therapists have encountered difficulties. Good judgment is required here, as well as reference to law, regulation and ethical standards, and perhaps one or more consultations. There is a significant difference between paying for an hour of therapy with bushels of fruit (in a rural or farming community) approximately equaling the therapist’s fee, as opposed to having the patient work at the rate of ten dollars an hour cleaning the therapist’s house (including the two bathrooms replete with magazines of various genres)! While bartering may not be prohibited, it is also not typically enthusiastically encouraged. Care must be taken to comply with any conditions established by applicable standards, guidelines, or laws and regulations.


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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