Ethics Committee Chair — Katie Busse, MS, LMFT

When a Client Requests a Letter

As a therapist, it is not unlikely that you will be asked to write a letter on behalf of a client or a potential client. These can range from general letters indicating that an individual was in treatment to recommending someone for an emotional support animal (ESA) to letters that may be presented in court. While this can seem like an innocuous request, there are several important ethical and legal factors to consider before complying with such a request. So, let’s jump right into what you need to know before you write your first or next letter for a client.

What to do:

• First and foremost, remember that you reserve the option to decline the request (Griffin, 2013). However, this may be different if you were required to provide information as part of a court-order or subpoena from a judge.
• Consider your scope of competence and practice before writing (Griffin, 2013). Always look at your education, training, and other factors that would impact your ability to provide an appropriate clinical opinion about a certain topic.
• Consider whether it would be appropriate for you to write such a letter given the client and the context (Griffin, 2013). For example, if a past client were to contact you and request a letter regarding their current functioning, it stands to reason that a current provider would be a more appropriate author of said letter. Similarly, if someone were to reach out asking you to write them a letter for an ESA, even though you’ve never worked with them, you could be setting yourself up for liability by writing a letter for someone you have not adequately assessed.
• Consult before you write (Griffin, 2013). Consult with colleagues, CAMFT, and/or your personal attorney. Consultation is a salient part of our profession and clinical decisions — this situation is a great example of that importance.
• Focus on providing only the necessary and factual information. While we more often hear about this with regards to collaboration after obtaining a release of information, the same is true when writing a letter. It’s the difference between “Client is such a great and kind person. They had xyz happen when they were a kid but I know they’re trying now” and “Client has demonstrated motivation and made progress towards their goals of identifying and implementing 2 copings per week.” It’s great to have a good connection with a client and think highly of them, but it’s more appropriate and relevant to focus on the facts.
• Consider the client’s privacy as well as the impact of the letter on the therapeutic relationship. Could a client’s privacy be compromised in ways they may not have considered by you writing a letter? Could the client be negatively impacted by reading the letter you wrote about them?
• Document your clinical reasoning behind why you decided to write or not write the letter, as well as the steps you took to come to that decision (Griffin, 2013).

What not to do:

• Write a letter that makes an evaluation of someone you never meet (CAMFT, 2011, Sec 8.7). Again, if you’ve never met the person, how can you say you’ve assessed them or can form a clinical opinion about them?
• Make a custody recommendation unless you have specific additional training to do so (CAMFT, 2011, Sec 8.8). Even if you’ve been working with a minor and their family, that does not necessarily mean you can speak to the fitness of either parent for custody.
• Agree without asking more questions or gathering more specific information regarding expectations before writing the letter (Griffin, 2013). Client privacy, the impact on the therapeutic relationship, conflicts of interest, etc -- there are a lot of factors you’ll need to explore to better understand the nature and outcome of such a request.

In summary, remember you reserve the right to decline letter requests. However, should you wish to write a letter, it’s important to consult, consider your scope, explore the impact on your client’s privacy, and avoid writing about topics for which you lack specific factual information.

Disclaimer: The preceding article does not constitute legal advice and is intended for educational purposes only. Always consult with a CAMFT attorney or another legal professional for any specific legal or ethical questions.

References

California Association of Marriage and Family Therapists [CAMFT] (2011). CAMFT Code of Ethics. Retrieved from www.camft.org/Portals/0/PDFs/AssocDocs/CodeOfEthics.pdf?ver=2019-06-04-093935-577

Griffin, M. (2013). It's What You Don’t Say. The Therapist. Retrieved from: https://www.camft.org/Resources/Legal-Articles/Chronological-Article-List/its-what-you-dont-say.

Katie Busse, LMFT, 122230, helps teens, young adults, and families in her private practice. Learn more about Katie by visiting her website at www.katiebussetherapy.com. She can be reached at 747.217.2257 or katie@katiebussetherapy.com.