Is It Ethical For A Therapist To Use A Collection Agency?

Cartoon Credit Jaime Buckley http://www.wantedhero.com/

A wile ago I appeared radio broadcast and mentioned the indiscriminate use of collection agencies as an example of bad practice. Some colleagues contacted me to say that they heard the broadcast. They asked why when the host of the radio show asked for an example of a "bad therapeutic practice", of all possibilities, I chose an example of a therapist turning debt over to a collection agency. Actually, they were complimentary of my presentation, However they were curious as to why I chose that particular example among so many possibilities.

Those who know me or have read any of my writings, know this has been my position for some years. However, it's a fair question and I will give as honest and as kind an answer as possible.

Aggressive collection of patient debt is always risky and dangerous for the patient AND perhaps as much if not more so for the therapist. If done at all, it should only be resorted to in the most extreme of cases and with very serious consideration of the negative consequences for the patient and therapist. I do not recommend it. I can't say that strongly enough. Usually it's far better to write it off as bad debt. It's business, don't let it get personal.

This is not a new position for me. One of the examples I often cite actually occurred in 1994. It is a matter of public record in the press and not a contrived or rhetorical situation in case someone would wish to believe that. What I left out on the brief comment on my website was this. When I heard that one of my own kind would actually sue one of their own patients for chump change it upset me beyond words. $12.68. That right, twelve dollars and sixty eight cents. So with that patient's consent (not my patient at the time BTW) I went down to the therapist's office (actually an agency) and paid the damn $12.68 myself. It made the press and the 11 o'clock news or so I was told. You see when you use a collection agency most expect volume and often they often don't discriminate between a true deadbeat and some poor person down on their luck. Such indiscriminate use of collection agencies are acts of incredible meanness or stupidity or both.

My views on the matter have not altered. I feel so strongly that turning a client over to a collection agency is bad for our clients and bad for our profession that I am updating my website to include this offer which may also be in a new article on fees that I have started. The offer is this. If anyone knows a patient of a mental health professional who: a) Has had their debt turned over to a collection agency, b) Sincerely believes that the therapist harmed them in some way; did not treat them properly or is taking unfair advantage of a power imbalance inherent in a therapist patient relationship, and c) Can present me some creditable independent evidence to support that view, I will offer my services pro bono for a consultation and referral.

If they obtain a full copy of their records which they should be able to in most states preferably including "psychotherapy notes" which may be possible in many states, I will review the record for "irregularities." If irregularities seem apparent, I will assist the patient in obtaining legal council and refer them to an independent practitioner for a second opinion or educate then on filing complaints with licensing boards, ethic committees etc. It's relative. The clinician may see this as retaliation but the patient may see it as the clinician retaliating for the patient's refusal to pay for poor service. Whose construct is closer to reality?

One thing providers need to keep in mind is that if patients bring a licensing board complaint or malpractice suit or go public it may not be simply because they are angry or have a transference problem or are acting out. It may be because they have actually been harmed by a provider who put their needs before their patients'. The complaint or suit is their way of seeking justice.

As with any product or service, consumers have the right to withhold payment if they received poor service, incompetent service or if promises weren't delivered. Obviously, opinions may differ but such differences should be resolved through negotiation or at least attempted. Legal action against a patient should be the very last resort- not the first.

I stand by my statement that any therapist who sees using collection agencies as anything but the last resort is to be avoided. If the patient feels he or she has cause, I encourage them to exercise legal remedies in self defense.

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