<p></p><p>&nbsp;</p><h2><a name="_Toc31009226">Preamble</a></h2><p>This module covers all ethical and professional considerations for neurotherapy clinicians and technicians. The practice of neurotherapy is both an art and a science. It will vary in terms of approach, modality, method of delivery, and services provided. This chapter covers a code of ethics that neurotherapist need adhere to. When working with patients, may situations can arise; if a situation is not covered in this chapter on ethics, it does NOT mean that ethics do not apply. While the specific wording behind these standards is important, it is the spirit and intent of these standards which must be applied to situations. Violation of these standards by any QEEG-D or neurotherapist ought to be brought to the Attention of the QEEG-D Certification Board, at: iqeegcb@gmail.com and/or 561-247-1347.</p><p>Neurotherapy members are encouraged to apply for membership to either the AAPB (Association of Applied Psychophysiology and Biofeedback) or ISNR (international Society for Neurofeedback and Regulation) for belonging to a larger board and for inclusion in a group of colleagues and professionals engaging in the same business. The professional standards adhered to by the professional organizations of neurofeedback professionals all maintain the highest ethics, values of competence, promotion of intellectual freedom, respect, integrity, honesty, fairness, and trustworthiness.</p><p>Because the trade organizations supporting and advocating for neurofeedback professionals are committed to the protection of human rights, they strive to maintain respect amongst other professional communities, fostered by professionalism, integrity and dignity.&nbsp; Clinicians must hold themselves accountable for their clients welfare as it pertains to the their neurotherapy regimens, and they mist limit their services only to those areas in which they have expertise and are competent.</p><p>&nbsp;</p><p>&nbsp;</p><h1><a name="_Toc31009227">RESPONSIBILITY TO PATIENT WELFARE</a></h1><p>The goal of the neurotherapist is to advance the patient’s well being and maintain their best interests at all times.</p><h3><a name="_Toc31009228">Non Discrimination</a></h3><p>Neurotherapists will not discriminate or deny services to anyone based upon religion, gender identity,&nbsp; sexual orientation, ethic or national origin, race, socioeconomic status, or disability. Within reason, neurotherapists make accommodations to treat all individuals within their scope of practice. If a neurotherapist believes someone is outside of their scope of practice (e.g. an infant), they will do their best to find a suitable referral for those seeking help.</p><p>&nbsp;</p><h3><a name="_Toc31009229">Dual Relationships</a></h3><p>A dual relationship is one that occurs outside of the neurotherapy clinic as a separate and distinct relationship during or after the termination of the neurotherapeutic relationship. Neurotherapists avoid dual relationships with patients that are able to impair professional judgment, as they are aware of their influential position in the patient-therapist dynamic. Not all dual relationships are unethical and some dual relationships cannot be avoided.</p><p><a name="_Toc31009230">Unethical dual relationships</a>&nbsp;are those wherein a therapist borrows money from a patient, hires a patient, engages in business ventures with a patent, or enters a close personal relationship with a patient (this applies to patient’s spouses, partners and family members, as well). Sexual contact, intimacy or intercourse with a patient during the therapeutic relationship or two years following the relationship is unethical and strictly prohibited. If a neurotherapist engages in intimacy with a former patient or their spouse or partner, or immediate family member, within two years of the termination of the patient-therapist relationship, the neurotherapist risks the revocation of their quantitative EEG diplomacy and/or their board certification in neurotherapy. This type of conduct is considered harmful and potentially exploitative to the patient.&nbsp;</p><h4><b>Treatment disruption, abandonment or termination&nbsp;</b></h4><p>It is a neurotherapists professional and clinical responsibility to maintain practices and procedures that assure undisrupted care. This may include providing contact information in case an emergency situation arises while the therapist is away. It is important that a neurotherapist uses clinical judgment when terminating a relationship, as termination must be done in an appropriate manner and based upon sound reason (e.g. the patient is not benefitting from treatment, continuing treatment is no longer beneficial or appropriate, the neurotherapist can no longer provide treatment due to extenuating circumstances, or in order to avoid an ethical conflict or problem). It is unethical to abandon&nbsp; to neglect a patient in treatment; if a therapist is unable to continue providing treatment, they must attempt to provide their patient an alternative health care professional for their accommodation.</p><h2><a name="_Toc31009231">Hygiene</a></h2><p>It is imperative that the neurotherapist maintains a clean and hygienic office for the protection of both clients and staff. This includes all equipment, sensors, pastes and gels used, preventing for cross contamination or any human byproduct (i.e. sweat, saliva, blood, etc.). Attached is a document concerning disinfecting in the time of COVID-19.</p><h3><a name="_Toc31009232">Financial Concerns</a></h3><p>It is unethical for a therapist to maintain a client relationship solely for financial gain, nor is it ethical to terminate a patient relationship for non-payment of fees, unless the termination is handled in a clinically appropriate manner. All services billed by the practitioner must be for clinical services provided directly by the clinician or by their technician.</p><h2><a name="_Toc31009233">At Home Training</a></h2><p>Neurotherapists recommending and enacting at home training are responsible for the patient’s (or patient’s care-takers) education and application of all neurofeedback modalities and their use. Since at home systems involve the neurotherapist not being present, the neurotherapist must take extra precautions to meet their responsibility to their patients.</p><p>Before implementing at home system use, a neurotherapist must consider the competence and capability of a patient or patient’s caretaker to administer treatments from an at home setting, and must be present via an online screen share for the initial training sessions to ensure the equipment and the set-up is appropriate. When at home training occurs, a neurotherapist must inform patients of the risk of at home training, consequences, limitations, and appropriate emergency responses, should a situation emerge. It is the neuerotherapist’s responsibility to ensure the patient signs all appropriate paperwork regarding at home training, its risks, consequences, and potential adverse effects before engaging in at home use.</p><h2><a name="_Toc31009234">Intake</a></h2><p>During the initial intake, a neurotherapist will get written informed consent from their patients and clients when providing clinical services, including a form indicating the patient is aware of the QEEG procedure (if being done) as well as the neurotherapy procedures at hand.</p><h2><a name="_Toc31009235">Disclosures</a></h2><p>A neurotherapist ought to provide clear information about the neurotherapy modalities used in easy to understand language so the patient can make an educated decision about partaking in neurotherapy. It is of paramount importance that the neurotherapist informas their patients of potential risks and benefits of therapy and any common side effects that occur from the treatment modalities they utilize.</p><p>It is strongly recommended that the neurotherapist informs their patient of their background, theoretical and professional orientation, education, training, and modalities of treatment.</p><h2><a name="_Toc31009236">Non-Neurotherapist Roles</a></h2><p>When a neurotherapist acts in a professional role other than the role of a neurotherapy provider (be it psychologist, psychotherapist, nurse, nutritionist, acupuncturist, chiropractor) they are acting soley within that role and may clarify, when necessary, which role they are acting in in order to prevent confusion.</p><h2>Supervisor, Supervisee, Educator and Student Responsibilities</h2>Neurotherapists maintain professional roles and boundaries when in the role of student or supervisor/educator. The supervisor/educator takes seriously their impact on their students and supervisees and, thus, do not exploit the trust and dependency of their supervisees. A neurotherapist does not engage in romantic or sexual relationships with supervisees/students (over whom they exercise professional authority).&nbsp;&nbsp;Other unethical acts include: borrowing money from students, engaging in a close personal relationship with a supervisee, engaging in a businesses venture with a supervisee, barter with supervisees, or engaging in any of the aforementioned with the student’s spouse. It is mandatory that a supervisor maintain their professional skills with recurring courses and trainings.<br><h2>Competence of Supervisee</h2><p>Neurotherapists make sure their supervisees are addressed and taught at the level of their competence and are not providing services before they are clinically capable.</p><p>&nbsp;</p><h2><a name="_Toc31009237">Consultation with Outside Parties and Referrals</a></h2><p>It is important that neurotherapists have access to professional communities of other clinicians doing similar work in the cases that they need to consult, collaborate with, and refer patients out to other professionals, physicians, and community resources. In cases where neurotherapy is not leading to desired results, neurotherapists ought to offer treatment alternatives that are appropriate for the patient’s symptoms.</p><h2>&nbsp;&nbsp;&nbsp;<a name="_Toc31009238">Treatment Decisions and Case Notes</a></h2><p>All mental health care practitioners keep notes of their patient sessions, including the patients subjective state, their demeanor and reported changes or challenges since the last neurotherapy session, as well as the protocol given at the time of the appointment in as much detail as is necessary. This latter form of note keeping may be kept in electronic format, but it is paramount that the neurotherapist maintains a backup copy of the treatments undertaken in the case of computer failure.</p><p>&nbsp;</p><h1><a name="_Toc31009239">Confidentiality</a></h1><p>A neurotherapist is held to the same levels of confidentiality as other mental health care practitioners: all information exchanged by the patient is confidential with these exceptions:</p><p>&nbsp;</p><p>1)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;if the patient is suicidal, in which case the neurotherapist has the obligation of staying with the patient until they can ensure their safety. The therapist may reach out to an emergency contact and ensure the patient is in the care of a close friend, spouse, or relative. If the patient seems unstable, it is the professional obligation of the neurotherapist to see that the patient is taken to the hospital, even if by an involuntary hold (a 5150 code). This may involve the police or calling 911 if the patient is resistant.</p><p>2)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;If the patient is abusing or knows of someone abusing an elderly person or a child (in which case it is the neurotherapists duty to reach out to the proper authorities (e.g. child protective services or the police);</p><p>3)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;If the patient is homicidal or threatening acting against another violently, in which case it is the neurotherapists duty to make sure all endangered parties are informed, by contacting the police.</p><p><b>&nbsp;</b></p><h2><a name="_Toc31009240">Limits of Neurotherapist’s Role and Contact</a></h2><p>&nbsp;A neurotherapists will act solely within the provision of their role as a neurotherapist and within the role of their professional license, if applicable. A chiropractor is free to do chiropractic work, an acupuncturist is free to do acupuncture, a psychotherapist is free to do psychotherapy, etc., but no neurotherapist is allowed to reach beyond the bounds of the professional license with any neurotherapy client. For example, it would be unethical for someone without a license in mental health care to conduct psychotherapy with a patient while doing neurotherapy. The therapist will also purchase liability insurance that covers the extent of their neurotherapeutic work, including all forms of neurostimulation and neurofeedback.</p><h2><a name="_Toc31009241">Competence</a></h2><p>A neurotherapist is expected to practice within the limits of their professional competence, based upon their experience, their education, and their training.&nbsp; It is also the therapist’s role to inform their patients about particular procedures and possible negative effects. A clinician who received the QEEG-D designation ought to have the competence of an intermediate practitioner and it is advised that they pursue their BCIA (Biofeedback Certification International Alliance) certificate before pursuing the QEEG-D or QEEG-T.</p><p>If a professional is serving in the role of a biofeedback or neurofeedback technician or assistant, they will engage in the practice only under the supervision of a qualified professional.&nbsp; Misrepresentation of one’s credentials, training, experience, degrees, or specialty is a violation of ethics and a violation of law in certain circumstances.</p><h2>&nbsp;<a name="_Toc31009242">Treatment Alternatives and Referring Out</a></h2><p>Sometimes a client will seek neurotherapy who would be much better suited by another form of treatment. Sometimes a patient will seek neurotherapy who has a condition that is more severe than the neurotherapist can address or is foreign to the neurotherapist. In other situations a patient may come to a neurotherapist without knowing what is wrong with them, in dealing with a severe situation. In these situations it is the ethical duty of the neurotherapist to consider the client’s best interests and either refer to an appropriate specialist for a more suitable treatment or appropriate assessment and diagnosis.</p><h2><a name="_Toc31009243">Complaints</a></h2><p>If a neurotherapist receives a filed complaint from a client, the board to which the complaint must first be presented is to the clinician’s professional licensure board, be it the American Psychological association, the American Nurses Association, the American Psychiatric Association, the American Medical Association, etc. The professional boards for the practice of neurotherapy, including the International Quantitative EEG Certification Board, The Biofeedback Certification International Alliance (BCIA) Board of Directors, and the Association of Applied Biofeedback and Psychophysiology (AAPB) will be the secondary board to determine whether or not the member failed to comply with either ethical and/or legal requisites.</p><h1><a name="_Toc31009244">Core Professional Values of Neurofeedback Professionals</a></h1><p>&nbsp;</p><p>These core professional values are borrowed from the AAPB Code of Ethics:</p><p>a)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Enhancing human development and improvement through the life span</p><p>b)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Honoring diversity and embracing a multicultural approach in support of the worth, dignity, and uniqueness of people within their social and cultural context</p><p>c)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Promoting social justice</p><p>d)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Safeguarding the integrity of the provider/client relationship</p><p>e)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Practicing in a competent and ethical manner</p><p>&nbsp;</p><br><p></p>