Director's Corner

Rachel Rothwell, LCSWC

We're Here to Help...

At Respire, the clinical and administrative staff truly enjoys working with families to support their needs. As with any relationship, however, our services are provided within a specified set of limits and boundaries. From a practical perspective, our boundaries help you, the client, better understand how our services are used to address your needs. In addition, they anchor our services within a moral and ethical framework.

What do limits and boundaries look like at Respire? 

Since the Health Insurance Portability and Accountability Act (HIPAA) passed in 2004, patient privacy and confidentiality have been at the forefront of discussions within healthcare. While many providers use confidentiality and privacy interchangeably, there are important distinctions between the concepts from a practical perspective.

Privacy refers to an individual's ability to control the access and release of information about a specific healthcare record.

Confidentiality is a formal agreement between individuals and providers about how private information will be handled, managed, and communicated. The adage, "what happens in a session, stays in a session," is a common colloquialism used to describe confidentiality from a layperson's perspective.

At Respire, we are committed to maintaining privacy and confidentiality. However, there are special circumstances when the information shared in the n session must be shared with others. The psychological ethical principles of beneficence and nonmaleficence guide our need for disclosure as our commitment to patient safety exceeds our need to maintain privacy or confidentiality.

Below are the specific circumstances in which our staff is required to report behaviors that might compromise patient safety. Page 3 of the 2023 client paperwork also details this information.

• when a patient presents as a danger to themselves or others
• when a patient or guardian authorizes the release of information
• when elder, child, or vulnerable individual abuse is suspected
• when a patient identifies a history of exploitation, including human trafficking

Clinicians at Respire also desire to support all clients that seek to obtain services. However, we do have limited availability. Working within our capacity and providing client appointments that balance work goals with self-care needs is another way we display limits within the clinical setting.

Before you schedule an appointment, please think about how you plan to be committed to treatment. Our clinicians book on a first come first, serve basis, and our availability is extremely limited. Please don't take a 12 p.m. time slot for your first appointment to "get in quickly" if you need a 5 p.m. time slot moving forward. This takes up a valuable spot from someone else, and you may risk not being seen in future sessions.

Your clinician is also limited by their scope of practice. As mental health therapists or clinicians, we do not prescribe medications or complete psychological evaluations. If you feel that psychiatry (consulting with a doctor about medication) or undergoing a psychological evaluation is necessary, don't hesitate to get in touch with your clinician to obtain a referral. Your clinician will educate you on how to best integrate a collaborative approach into your care. 

Now let's talk about boundaries!

All relationships require boundaries, and the relationship between client and therapist is no different. While we work to support all our client's needs, we must refrain from entrenching ourselves in the family decision-making process. Instead, we work with clients to identify the best way to address needs and will provide referrals so that clients find the support they need in the community. Our office also conducts a parenting education group for parents who want to obtain more in-depth skills.

Another boundary we have is that we do not accept our clients on social media. Although we recognize that connecting via social media is an easy form of communication, this type of informal outreach can blur the lines between clinician and client. Your clinician will identify the most appropriate communication methods at the first client session.

There are many other boundaries we employ as staff at Respire, but we hope that the ones outlined above clarify how we operate to promote your needs. Should you need additional information, please connect with your clinician.