The Importance of Establishing Client Status in the Treatment Room
Written by Leslie S. Tsukroff, MSW, LCSW
Founder and Executive Director of Leslie S. Tsukroff, Inc.
What Is a Collateral?
A collateral is an individual (s) invited to participate in the identified client’s treatment. A collateral may be a friend, partner, family member or close contact whose involvement is viewed as helpful to the identified client. A collateral is not a client.
Why May Involving Collaterals in Treatment Be Useful?
Research has shown the inclusion of collaterals can improve treatment outcome, as they can provide meaningful information about the client and perspective on issues relevant to the client. Additionally, oftentimes it is helpful for collaterals to attend for the purpose of obtaining psycho-education regarding the client’s struggles, diagnosis or symptoms or to be co-trained on certain strategies, techniques and tools to better support and assist the client in carrying out treatment goals, implementing strategies or to enact am agreed-upon safety plan.
What is a Consent for Collateral Attendance Waiver/Contract?
A Consent for Collateral Attendance Waiver/Contract is the document signed by an individual (s)s who joins the client’s session as an informant or for support. This contract outlines the collateral’s role, rights responsibilities and limitations of participating in the client’s session(s), as well as the risks and benefits when doing so. As with any informed consent document, it also outlines the clinician’s role, rights, and obligations to the collateral, the client and to the therapeutic process.
Because collaterals are not clients, they are not afforded the same privacy protections, rights to confidentiality and access to the client’s medical record as the client; they must be informed of this. Collaterals, because of their non-client status do not have their own medical record, do not complete the clinician’s paperwork, their issues are not assessed, and a diagnosis is not provided. While they may be referenced in the client’s treatment plan, a treatment plan is not developed for them.
Collaterals must be advised of the practitioner’s ethical duty and a legal mandate to report suspected abuse, neglect and harm (as well as other risks) to the appropriate authority or to take proper action when a duty to warn or protect is triggered (these laws are state-specific). Furthermore, when collaterals are involved, it is best practice for providers to address boundaries and dual relationships, collaterals converting to client status in the practice, and circumstances that might warrant referral for formal assessment, diagnosis and treatment.
When Should the Consent for Collateral Attendance Waiver/Contract Be Provided?
Ideally, this contract should be provided to the collateral either before they participate in the session or at the outset of the first session. As with other agreements, it should be in written format, reviewed verbally and should be signed by the collateral, the client and the clinician. It should be revisited as needed throughout the term the collateral is attending. If there is a break in the collateral’s involvement in the identified client’s treatment, then a new Consent for Collateral Attendance Waiver/Agreement should be executed.
How Do I Know If I Should Have Someone Sign a Consent for Collateral Attendance Waiver/Agreement?
Professional codes of ethics as well as state licensure regulations stress the importance of clarifying who holds client status when another party is invited into the treatment room. We are instructed to ensure all parties understand their own and each other’s roles and the corresponding rights, responsibilities and limitations when more than one person is involved in treatment. Therefore, whenever you are working with an individual as the identified client and others are included in their appointments, even if only occasionally, a Consent for Collateral Attendance Waiver/Agreement should be implemented.
Want To Learn More About Collaterals and Preserving Client Confidentiality When Partners/Spouses Participate In Counseling Sessions? Join me on Saturday, June 1, 2024 for "Avoiding the Slippery Slope in Private Practice: Managing Complex Ethical Issues."
Leslie, do you have a sample Consent for Collateral Attendance Waiver/Agreement?
Yes. Contact me @ LTsukrofflcsw@Hushmail.com to find out how to access.
This document is for general informational purposes only and is not intended to be used as advice (legal, ethical or technical) or as a substitute for the guidance of an attorney or an individualized consultation. It does not address all possible clinical, legal and ethical issues that may arise, nor does it take into consideration the particular circumstances, nuances or concerns of the situation or person(s) involved. Leslie S. Tsukroff, Inc. does not assume any responsibility or liability for any errors or omissions in its content.
© Leslie S. Tsukroff, Inc. 2024 (All Rights Reserved)
This article originally appeared in Leslie’s March 2024 Newsletter