When questioning your work with a client, ever consider consulting Artificial Intelligence (AI)? Have you considered the ethical and legal implications?
SE: I have tried cognitive restructuring first. AI suggested the intervention.
SP: Let’s start here. Help me understand how AI prompted the recommendation for cognitive restructuring.
SE: I asked AI, “what counseling interventions would help an adolescent female overcome social anxiety?” AI stated cognitive restructuring has been found to be helpful.
SP: What evidence did AI offer concerning the interventions’ effectiveness?
SE: No specific study was shared, just general feedback.
SP: When you say general feedback, do you mean reports from clinicians or clients?
SE: I don’t know.
SP: Did AI offer any scholarly sources?
SE: I did ask for resources to help me implement the intervention and some websites were shared. I read a few of them to see how cognitive restructuring has been used in sessions. Some of them had scholarly sources. I feel some of the resources were helpful for this client.
SP: I see that in your last session’s progress note for this client, you mentioned in the assessment that your client meets criteria for the diagnosis of social anxiety disorder and cited AI.
SE: Yeah, according to AI, my client meets the criteria.
SP: Are the criteria reflective of the DSM-5-TR?
SE: They should be.
SP: For billing purposes, you will be required to provide the appropriate DSM diagnosis. You will need to ensure the client’s symptoms meet the DSM criteria. Share with me how you found AI to account for your whole client. For instance, some of the information you gathered from the intake, and you learned through your sessions thus far.
SE: Well, I couldn’t share some of that information due to the client’s right for privacy and confidentiality, so I had to just generalize to populations like her being an adolescent female.
SP: Knowing these limitations, the need to research AI for sources and then research the sources’ relevance, why not just search for scholarly sources first?
SE: Open AI is easy and accessible with my phone so I can complete my notes on site between clients.
SP: Do you have your phone with you now?
SE: Yes, why?
SP: Would you be open to trying something using your phone?
SE: Yeah
SP: Please type in Google scholar in your browser and click on the link to open it.
SE: Okay, got it.
SP: Complete the same search here in Google scholar that you did previously with AI.
SE: Got it.
SP: How are these results compared to what you received in AI?
SE: Some of the relevant sources shared by Open AI came up. A lot of research-based articles came up in Google scholar.
SP: I want to take a moment to pause and offer some reflection on your experiences thus far with AI, progress notes, diagnosis, scholarly sources, and search for appropriate client interventions in general. Imagine going to court based on your work with a client and they claim you engaged in malpractice and unethical business practices based on your diagnosis, would you feel confident in sharing with the judge your current process in working with your clients?
SE: Not really to be honest. I feel like I am a bit overwhelmed, and AI has been a great tool to help me not stay at the office for hours after working with clients to complete documentation, but I am not always confident in what I am doing.
SP: Remember that confidence comes with time and this is why you have built in parameters right now to support… required supervision, open consultation hours with numerous senior clinicians, required team meetings for case conceptualization.
SE: I am a bit fearful people will not think I am good at my job and will no longer send me clients.
SP: What are your thoughts about a few clients that you feel confident in working with versus many you are unsure how to effectively support?
SE: I would rather feel confident, but I do not want to loose my job.
SP: First and foremost, thank you for your honesty. My role is to also support you to grow as a clinician and aid you with your development. Let’s agree for the next month, we will keep your caseload where it is at and revisit later to grow again.
SE: Thank you; I just don’t want my colleagues to think I can’t do my share.
SP: We all have seasons of life where we may need to provide best practices with our clients.
SE: I know.
SP: Remember, your ethical obligation, as well as mine, is to the welfare of theclients first and foremost. What would you rather tell the judge you used to guide your work and decisions with the client, AI or Scholarly resources?
SE: Scholarly resources.
SP: So why use AI? You shared the ease of access. Something to consider is also how you use it. I am not going to say all AI is bad, because there is also a great deal of research highlighting the benefits of AI. However, engaging with AI considering your compliance with HIPAA as well as your professional standards of practice is essential.
I proposed to you earlier about the client consideration and the credibility of the responses. There is a free training course I would suggest you complete that examines AI implementation for mental health providers. Here are the objectives for the course [shares screen]… how do you feel about this course being able to support your confidence with client work with use of AI?
SE: The course seems to cover many areas I am struggling with and supports the use of AI, which I like, so it may be a good fit for me.
SP: Instead of completing the three additional intakes assigned for you this week, would you be open to completing the three-hour training by our next supervision session next week?
SE: I think that is doable.
With AI specifically, we understand our world is consistently increasing its embrace. In healthcare alone, numerous AI platforms have been developed with the intention of supporting clinicians with their work with clients from advertising, intakes, platform capabilities, and even documentation. However, understanding how to distinguish between tools that align with your professional standards of practice is essential to not only protect the clinicians but also the clients. Furthermore, understanding how to implement the tools appropriately for your role with compliance to your profession’s ethical and legal parameters is critical.
File under: Law & Ethics, Musings and Reflections
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A supervisee of mine recently introduced AI into our supervision sessions. My supervisee explained how they came to see the treatment plan development in relation to the feedback received through consultation with AI. In examining a specific client case my supervisee felt they were stuck with, we delved into exploration of AI professional relevance. Below is an excerpt reflective of one of our sessions:
Bringing AI into the Supervisory Conversation
Supervisee (SE): I am really struggling to understand why my approaches with the client do not seem to be resulting in the client’s therapeutic progression. Supervisor (SP): Tell me about some of the interventions you have used and how you came to establish their appropriateness for this client.SE: I have tried cognitive restructuring first. AI suggested the intervention.
SP: Let’s start here. Help me understand how AI prompted the recommendation for cognitive restructuring.
SE: I asked AI, “what counseling interventions would help an adolescent female overcome social anxiety?” AI stated cognitive restructuring has been found to be helpful.
SP: What evidence did AI offer concerning the interventions’ effectiveness?
SE: No specific study was shared, just general feedback.
SP: When you say general feedback, do you mean reports from clinicians or clients?
SE: I don’t know.
SP: Did AI offer any scholarly sources?
SE: I did ask for resources to help me implement the intervention and some websites were shared. I read a few of them to see how cognitive restructuring has been used in sessions. Some of them had scholarly sources. I feel some of the resources were helpful for this client.
SP: I see that in your last session’s progress note for this client, you mentioned in the assessment that your client meets criteria for the diagnosis of social anxiety disorder and cited AI.
SE: Yeah, according to AI, my client meets the criteria.
SP: Are the criteria reflective of the DSM-5-TR?
SE: They should be.
SP: For billing purposes, you will be required to provide the appropriate DSM diagnosis. You will need to ensure the client’s symptoms meet the DSM criteria. Share with me how you found AI to account for your whole client. For instance, some of the information you gathered from the intake, and you learned through your sessions thus far.
SE: Well, I couldn’t share some of that information due to the client’s right for privacy and confidentiality, so I had to just generalize to populations like her being an adolescent female.
SP: Knowing these limitations, the need to research AI for sources and then research the sources’ relevance, why not just search for scholarly sources first?
SE: Open AI is easy and accessible with my phone so I can complete my notes on site between clients.
SP: Do you have your phone with you now?
SE: Yes, why?
SP: Would you be open to trying something using your phone?
SE: Yeah
SP: Please type in Google scholar in your browser and click on the link to open it.
SE: Okay, got it.
SP: Complete the same search here in Google scholar that you did previously with AI.
SE: Got it.
SP: How are these results compared to what you received in AI?
SE: Some of the relevant sources shared by Open AI came up. A lot of research-based articles came up in Google scholar.
SP: I want to take a moment to pause and offer some reflection on your experiences thus far with AI, progress notes, diagnosis, scholarly sources, and search for appropriate client interventions in general. Imagine going to court based on your work with a client and they claim you engaged in malpractice and unethical business practices based on your diagnosis, would you feel confident in sharing with the judge your current process in working with your clients?
SE: Not really to be honest. I feel like I am a bit overwhelmed, and AI has been a great tool to help me not stay at the office for hours after working with clients to complete documentation, but I am not always confident in what I am doing.
SP: Remember that confidence comes with time and this is why you have built in parameters right now to support… required supervision, open consultation hours with numerous senior clinicians, required team meetings for case conceptualization.
SE: I am a bit fearful people will not think I am good at my job and will no longer send me clients.
SP: What are your thoughts about a few clients that you feel confident in working with versus many you are unsure how to effectively support?
SE: I would rather feel confident, but I do not want to loose my job.
SP: First and foremost, thank you for your honesty. My role is to also support you to grow as a clinician and aid you with your development. Let’s agree for the next month, we will keep your caseload where it is at and revisit later to grow again.
SE: Thank you; I just don’t want my colleagues to think I can’t do my share.
SP: We all have seasons of life where we may need to provide best practices with our clients.
SE: I know.
SP: Remember, your ethical obligation, as well as mine, is to the welfare of theclients first and foremost. What would you rather tell the judge you used to guide your work and decisions with the client, AI or Scholarly resources?
SE: Scholarly resources.
SP: So why use AI? You shared the ease of access. Something to consider is also how you use it. I am not going to say all AI is bad, because there is also a great deal of research highlighting the benefits of AI. However, engaging with AI considering your compliance with HIPAA as well as your professional standards of practice is essential.
I proposed to you earlier about the client consideration and the credibility of the responses. There is a free training course I would suggest you complete that examines AI implementation for mental health providers. Here are the objectives for the course [shares screen]… how do you feel about this course being able to support your confidence with client work with use of AI?
SE: The course seems to cover many areas I am struggling with and supports the use of AI, which I like, so it may be a good fit for me.
SP: Instead of completing the three additional intakes assigned for you this week, would you be open to completing the three-hour training by our next supervision session next week?
SE: I think that is doable.
Final, but not Last Considerations
Lesson here, as a professional counselor navigating ethical best practices, you are encouraged to seek guidance from scholarly sources. If you don’t feel comfortable bringing your documentation in front of a judge, it is probably not the most ethical decision you can make. Applying ACA’s step 6 of the Practitioner’s Guide to Ethical Decision-Making model, application of the test of publicity, can further highlight if the choices you are making in the work with your client are choices you would be proud to stand by.With AI specifically, we understand our world is consistently increasing its embrace. In healthcare alone, numerous AI platforms have been developed with the intention of supporting clinicians with their work with clients from advertising, intakes, platform capabilities, and even documentation. However, understanding how to distinguish between tools that align with your professional standards of practice is essential to not only protect the clinicians but also the clients. Furthermore, understanding how to implement the tools appropriately for your role with compliance to your profession’s ethical and legal parameters is critical.
File under: Law & Ethics, Musings and Reflections