Another consideration in the ethicsof marriage and family therapy is technology.
With increasing use of technology, from email to text to social media,it is rare to find a therapist who uses none of these. It is used constantly between therapists andclients and in the management of information. These things cannot be ignored and must be used ethically and correctlyunder the law. Transferring andcollecting information must be done in a way that ensures patient privacy andpersonal email should never be used in contacting a client.
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The use of technology can be a great resourcein marriage and family therapy when used appropriately and responsibly.This chapter discusses multiple/dualrelationships and the ethics surrounding it. There is to be absolutely no intimacy between a therapist and his or herclients or former clients. There is alsoto be no intimate relationships for years after with any person associated withor related to the client. By havingclear expectations regarding the therapeutic relationship, many of these issuescan be avoided and potential pitfalls may be recognized.
Conducting therapy with friends or acquaintancesis also not appropriate because it blurs the lines and may entail harmfulmotives. Because of the power andprestige that their title holds, therapists have a considerable amount of powerover the current and former clients. Itmay disrupt a client’s ability to make clear and rational decisions and may cloudtheir judgment when it comes to entering a relationship with a therapist. This power should never be abused or takenlightly. “When therapist-client expectationsare clearly defined and compatible, role obligations are convergent, and thepower differential is small, there is much less danger that harm will ensue”.
Chapter 8 This chapter also brings up mentalhealth services under managed care plans. These plans usually limit the number of sessions that are allowed orhave a maximum for allowable treatment costs. It is important to remember that under these plans, time is limited intherapy and treatment goals need to be rapidly formulated and carried out. This can lead to a lack of faith in atherapist’s ability to gain positive outcomes in therapy and can sometimes be inadvertentlycommunicated to the client. The DSM raises ethical concerns forMarriage and Family Therapists through: a) incompatibility of orientations, b)stigma of diagnosis, c) misrepresentation of diagnosis, and d) competence todiagnose. Marriage and family therapy isbased in General Systems Theory but the DSM has an individualistic view ofmental disorders. There is an ethicalconflict concerning how to define a problem for third-party payments.
Even when seeing a family, a therapist willhave to diagnose an individual mental disorder to ensure reimbursement frominsurance companies. These diagnoses mayhold a stigma for families and for individuals within that unit. It is important to take that intoconsideration when considering a diagnostic code. It should be addressed in the informedconsent and include both the benefits and the risks. Another consideration is that many MFT’s havenot had adequate training in using the DSM. If not covered in our graduate studies, we should make every effort atacquiring skills and learning how to use it and diagnose properly.Chapter 7Literature has shown that “separationfrom the victimizer will maximize a victim’s psychological growth, facilitate amore objective assessment of the relationship, and reduce immediate potentialof injury or death”.
Because thebenefits outweigh the harm, a therapist could use their influence to encouragethe victim to leave the perpetrator. Theprinciple of nonmaleficence is “above all, do no harm”. If a therapist does not encourage a client toleave an abusive relationship, they appear to be violating this principle. Ways of doing this include providing themwith research findings and educating them on the dangers of staying with the abusivepartner. If by any chance the two wantto remain together, interventions must be put into place that include safety, education,support, and a contract of nonviolence.
This chapter discussed issuesrelated to intimate partner violence. While mandated reporting covers child and elder abuse, it does not coveradults. It is thought that since theyare adults, they could leave if they wanted to. “Offenders differ in many ways including the severity of their violence,the generality of violence, and the presence or absence of psychopathology orpersonality disorders”. While atherapist has no obligation to report this, they should use their expert powerin influencing clients in an IPV circumstance. They should be a reliable resource, supportive of their client’swelfare. Chapter 6 The final part of this chapter focusedon paradoxes. This is a type of interventionwhere the therapist prescribes the symptom and proposes that they continuetheir dysfunctional pattern(s) of behavior.
They encourage these symptoms in hopes of noncompliance, thereforeeliminating the symptom. They should notbe spur-of-the-moment ideas or acted upon with limited data. “Ethical, responsible use of a paradox requiresthe therapist’s competency and experience gained from a thorough understandingof the role of the symptom within the relationship”. Therapy can cause increaseddistress in the system as change occurs in the individual. Therapists must balance the well-being of aclient against what is best for the entire system. They have a duty to serve as agents of changewhile ensuring that they are providing value-sensitive care. They also face the task of trying to conveneadditional family members for upcoming sessions. This is not always easy to accomplish.
Coercion of reluctant family members isunethical, so there are two other ways of accomplishing this. The first is through enforcing. This is when therapists use referral agentsto exert pressure to come together for sessions. The second is through enabling. The therapist can either increase attractivenessfor participation through a face-to-face meeting or can decrease the attractivenessof being absent.
It’s important to tryyour best to have all family members be present as conducting individualtherapy for relational issues bears substandard results.The therapist is an agent ofchange. They can have the role of theteacher, the catalyst, or the collaborator. There is a potential for misuse of power when it encourages the client’sdependence. Therapists should relate toclients in a way that makes them have self-responsibility. This can be accomplished by getting clientsto actively participate in the process of therapy. Chapter 5 Clientsalso need to be told that marriage and family therapy may have outcomes thatare undesirable for one or more family members. Informed consent should be used to clearly state the goals of therapyand to inform the family members about what procedures will be used, the moreprobable consequences of those procedures, and the risk of therapy.
“Familiesneed factual information to make an informed decision, but they also need thetherapist’s support, encouragement, and optimism for taking this risky step”.Mandatory ethical decisions areusually uncomplicated but discretionary ones may have many acceptableactions. This gets more complicated withcouples and families. Having multipleclients can cause issues for therapists regarding the proper interventions. What may be good for one member, may not bein the other’s best interest. Accordingto the AAMFT, “In the context of couple, family, or group treatment, thetherapist may not reveal any individual confidences to others in the clientunit without the prior written permission of that individual”. You’ll encounter these dilemmas surroundingthe three types of family secrets.
1) Shared family secrets known toand kept by all family members. 2) Internal family secrets known to and kept bysome family members. 3) Individual secrets known and kept by individualfamily members. There are two ways youcan handle this.
The first involves treatingeach partner or family member as if they are an individual client. The second is to develop a policy of non-secrecy. Some therapists use a combination of themboth to determine what would be most beneficial for the entire family. Chapter 4 Through informed consent,therapeutic contracts, and professional disclosure statements, clients shouldbe informed about the specific things related to therapy. These include the therapeutic approach, lengthand frequency of sessions, cost/method of treatment, mutual expectations intherapy, each party’s responsibilities, and introduction of therapist’s qualifications. A client’s privacy and confidentiality arethe cornerstone of ethics. Exceptions tothis are child/elder abuse or neglect and risk of harm to the client or others.
Ethical care means acting in thebest interest of the client. Autonomy,beneficence, nonmaleficence, justice, and fidelity are the foundationalprincipals that guide this theory. Codesof ethics help professionals in dealing with potential dangers from threegroups: The government, other professionals,and the public. There are two models thatguide ethical decision-making: The KitchenerModel and the Koocher & Keith-Spiegel Model. Both provide therapists with steps/processesto interpret certain situations and act in an ethical manner while evaluatingrights, responsibilities, and welfare for all involved. Van Hoose concluded that counselors were probablyacting in ethically responsible ways if they: a) Maintained personal andprofessional honesty. b) Had the best interest of the client. c) Acted withoutmalice or personal gain.
d) Can justify their actions as best judgment. Above all, clients must take priority. Therapeutic relationships should bemaintained only if clients are benefiting from them.Chapter 3 There are also three differenttypes of power: legitimate power,referent power, and expert power. Legitimatepower is found in hierarchical structures. Referent power is the power to influence that is noncoercive and highlypersonalized, and expert power influences based on knowledge, skills, experience,and competence. The sources of powercome together with layers of value and emerge as “couplets”. There are three different types ofvalues: institutional values, personal values, and professional values.
“Institutional values in a system typicallyinvolve codifying rules, standards, procedures, and even hierarchicalrecognition of professional and nonprofessional representations of an institution”. Personal values are what we considerright/wrong or good/bad. Therapistsincorporate their personal values into practice, but it is essential that theyrecognize their influence on clients. They cannot be the only source of value in the therapeutic relationship. Professional values reflect “knowledge and experiencesacquired through relationships with other professionals related to ethicalpropriety, accepted practices, legal constraints, and even therapeutic tradition”.This chapter discussed systemicepistemology, different layers of values, and different forms of power.
There are four basic propositions of thesystemic worldview. 1) Relationships arethe focus of study. 2) Relationships can be isolated for study anddefined. 3) Causation is circular within relationships.
4) Therapeutic change occurs through social relationships. There are, however, certain views thatchallenge this way of thought. The firstis the Feminist Critique. This viewchallenged the field’s patriarchy and views on domestic violence.
The second is the Self in the System. There has been an increasing desire todevelop models which bridge the gap between self and the system. Over time, there have been evolvingepistemologies.
We should not bechoosing between a “theory of persons and a theory of persons in relationships”. The book recommends using a wide-angle lensand being able to incorporate different theories into marriage and familytherapy.Chapter 2 Since everyone holds a differentvalue system, it is important for practitioners to balance their personalworldview with those of their clients and to have respect for cultural andpersonal differences. This is calledvalue-sensitive care. As a therapist, itis important to be continually self-aware and to examine what values we use in ourprofessional decisions. If we fail toexamine this, we may significantly hinder our ability to assist clients.
We can “check vision” through continuingeducation, consultation, supervision, and even our own therapy. This chapter discussed the relevanceof values within our professional lives. We were asked “What do values have to do with a text about ethical,legal, and professional issues in marriage and family therapy?” The answer is almost everything. Values are the foundation of all that we doin our ethical, legal, and professional decisions.
They are a reference point for these decisionsand they guide us in our actions. Our valuesare influenced by our race, culture, class, religion, gender, and sexual orientation. The combination of these factors creates aunique value structure for both therapists and clients. Chapter 1