Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42California Biofeedback — Fall 2016 6 Licensed mental health professionals who are conversant with biofeedback and neurofeedback confront an ethical di- lemma that deserves ongoing discussion. On the one hand, they are persuaded that biofeedback could be helpful to many of their clients, and on the other they are constrained by insurance guidelines in terms of what services they may bill for. Practitioners are ethically bound to deliv- er their best service to their clients, and yet insurance guidelines come with the force of law behind them. We are aware that within these hard constraints a more fluid situation is start- ing to develop. Many practitioners resolve the ethical dilemma privately, simply bill- ing for psychotherapy even if the session involves biofeedback or neurofeedback as well. Their ethical choice is resolutely in favor of their client’s best interest. They are willing to take chances with their per- sonal futures. Yet others follow a psycho- therapy session with a window of time for biofeedback or neurofeedback for which they do not charge. One psychologist who used this strat- egy consistently with his Medicare clients was visited at one point by the gendar- merie looking for Medicare fraud. They demanded to see all the records for his Medicare clients and then they visited each of them for an interview. Fortu- nately, the practitioner had explained his policy to each of them at the outset, and by and large they remembered! The inves- tigators came back to tell him to keep up the good work. Prudently he also decided at that point to keep a signed copy of his written policy with each client record. That would have avoided the visits to his clients, which of course were uncomfort- able for all involved. The above remedy is not ideal, al- though it may be unavoidable in the case of Medicare. There are other low-risk strategies that might be considered for the general case. It can be argued, for ex- ample, that the clinician acquainted with psychophysiology might well be advan- taged in his conduct of psychotherapy if he had available information on physio- logical measures on the client throughout the session. The measures would be for his own information in first instance. The salient information would be con- veyed to the client verbally, and in time it Our Primary Ethical Dilemma Siegfried Othmer