Another consideration in the ethics
of 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 and
clients and in the management of information.
These things cannot be ignored and must be used ethically and correctly
under the law. Transferring and
collecting information must be done in a way that ensures patient privacy and
personal email should never be used in contacting a client. The use of technology can be a great resource
in marriage and family therapy when used appropriately and responsibly.
This chapter discusses multiple/dual
relationships and the ethics surrounding it.
There is to be absolutely no intimacy between a therapist and his or her
clients or former clients. There is also
to be no intimate relationships for years after with any person associated with
or related to the client. By having
clear expectations regarding the therapeutic relationship, many of these issues
can be avoided and potential pitfalls may be recognized. Conducting therapy with friends or acquaintances
is also not appropriate because it blurs the lines and may entail harmful
motives. Because of the power and
prestige that their title holds, therapists have a considerable amount of power
over the current and former clients. It
may disrupt a client’s ability to make clear and rational decisions and may cloud
their judgment when it comes to entering a relationship with a therapist. This power should never be abused or taken
lightly. “When therapist-client expectations
are clearly defined and compatible, role obligations are convergent, and the
power differential is small, there is much less danger that harm will ensue”.
This chapter also brings up mental
health services under managed care plans.
These plans usually limit the number of sessions that are allowed or
have a maximum for allowable treatment costs.
It is important to remember that under these plans, time is limited in
therapy and treatment goals need to be rapidly formulated and carried out. This can lead to a lack of faith in a
therapist’s ability to gain positive outcomes in therapy and can sometimes be inadvertently
communicated to the client.
The DSM raises ethical concerns for
Marriage and Family Therapists through: a) incompatibility of orientations, b)
stigma of diagnosis, c) misrepresentation of diagnosis, and d) competence to
diagnose. Marriage and family therapy is
based in General Systems Theory but the DSM has an individualistic view of
mental disorders. There is an ethical
conflict concerning how to define a problem for third-party payments. Even when seeing a family, a therapist will
have to diagnose an individual mental disorder to ensure reimbursement from
insurance companies. These diagnoses may
hold a stigma for families and for individuals within that unit. It is important to take that into
consideration when considering a diagnostic code. It should be addressed in the informed
consent and include both the benefits and the risks. Another consideration is that many MFT’s have
not had adequate training in using the DSM.
If not covered in our graduate studies, we should make every effort at
acquiring skills and learning how to use it and diagnose properly.
Literature has shown that “separation
from the victimizer will maximize a victim’s psychological growth, facilitate a
more objective assessment of the relationship, and reduce immediate potential
of injury or death”. Because the
benefits outweigh the harm, a therapist could use their influence to encourage
the victim to leave the perpetrator. The
principle of nonmaleficence is “above all, do no harm”. If a therapist does not encourage a client to
leave an abusive relationship, they appear to be violating this principle. Ways of doing this include providing them
with research findings and educating them on the dangers of staying with the abusive
partner. If by any chance the two want
to remain together, interventions must be put into place that include safety, education,
support, and a contract of nonviolence.
This chapter discussed issues
related to intimate partner violence.
While mandated reporting covers child and elder abuse, it does not cover
adults. It is thought that since they
are 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 or
personality disorders”. While a
therapist has no obligation to report this, they should use their expert power
in influencing clients in an IPV circumstance.
They should be a reliable resource, supportive of their client’s
The final part of this chapter focused
on paradoxes. This is a type of intervention
where the therapist prescribes the symptom and proposes that they continue
their dysfunctional pattern(s) of behavior.
They encourage these symptoms in hopes of noncompliance, therefore
eliminating the symptom. They should not
be spur-of-the-moment ideas or acted upon with limited data. “Ethical, responsible use of a paradox requires
the therapist’s competency and experience gained from a thorough understanding
of the role of the symptom within the relationship”.
Therapy can cause increased
distress in the system as change occurs in the individual. Therapists must balance the well-being of a
client against what is best for the entire system. They have a duty to serve as agents of change
while ensuring that they are providing value-sensitive care. They also face the task of trying to convene
additional family members for upcoming sessions. This is not always easy to accomplish. Coercion of reluctant family members is
unethical, so there are two other ways of accomplishing this. The first is through enforcing. This is when therapists use referral agents
to exert pressure to come together for sessions. The second is through enabling. The therapist can either increase attractiveness
for participation through a face-to-face meeting or can decrease the attractiveness
of being absent. It’s important to try
your best to have all family members be present as conducting individual
therapy for relational issues bears substandard results.
The therapist is an agent of
change. They can have the role of the
teacher, the catalyst, or the collaborator.
There is a potential for misuse of power when it encourages the client’s
dependence. Therapists should relate to
clients in a way that makes them have self-responsibility. This can be accomplished by getting clients
to actively participate in the process of therapy.
also need to be told that marriage and family therapy may have outcomes that
are undesirable for one or more family members.
Informed consent should be used to clearly state the goals of therapy
and to inform the family members about what procedures will be used, the more
probable consequences of those procedures, and the risk of therapy. “Families
need factual information to make an informed decision, but they also need the
therapist’s support, encouragement, and optimism for taking this risky step”.
Mandatory ethical decisions are
usually uncomplicated but discretionary ones may have many acceptable
actions. This gets more complicated with
couples and families. Having multiple
clients can cause issues for therapists regarding the proper interventions. What may be good for one member, may not be
in the other’s best interest. According
to the AAMFT, “In the context of couple, family, or group treatment, the
therapist may not reveal any individual confidences to others in the client
unit without the prior written permission of that individual”. You’ll encounter these dilemmas surrounding
the three types of family secrets.
1) Shared family secrets known to
and kept by all family members. 2) Internal family secrets known to and kept by
some family members. 3) Individual secrets known and kept by individual
family members. There are two ways you
can handle this. The first involves treating
each 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 them
both to determine what would be most beneficial for the entire family.
Through informed consent,
therapeutic contracts, and professional disclosure statements, clients should
be informed about the specific things related to therapy. These include the therapeutic approach, length
and frequency of sessions, cost/method of treatment, mutual expectations in
therapy, each party’s responsibilities, and introduction of therapist’s qualifications. A client’s privacy and confidentiality are
the cornerstone of ethics. Exceptions to
this are child/elder abuse or neglect and risk of harm to the client or others.
Ethical care means acting in the
best interest of the client. Autonomy,
beneficence, nonmaleficence, justice, and fidelity are the foundational
principals that guide this theory. Codes
of ethics help professionals in dealing with potential dangers from three
groups: The government, other professionals,
and the public. There are two models that
guide ethical decision-making: The Kitchener
Model and the Koocher & Keith-Spiegel Model. Both provide therapists with steps/processes
to interpret certain situations and act in an ethical manner while evaluating
rights, responsibilities, and welfare for all involved. Van Hoose concluded that counselors were probably
acting in ethically responsible ways if they: a) Maintained personal and
professional honesty. b) Had the best interest of the client. c) Acted without
malice or personal gain. d) Can justify their actions as best judgment. Above all, clients must take priority. Therapeutic relationships should be
maintained only if clients are benefiting from them.
There are also three different
types of power: legitimate power,
referent power, and expert power. Legitimate
power is found in hierarchical structures.
Referent power is the power to influence that is noncoercive and highly
personalized, and expert power influences based on knowledge, skills, experience,
and competence. The sources of power
come together with layers of value and emerge as “couplets”.
There are three different types of
values: institutional values, personal values, and professional values. “Institutional values in a system typically
involve codifying rules, standards, procedures, and even hierarchical
recognition of professional and nonprofessional representations of an institution”. Personal values are what we consider
right/wrong or good/bad. Therapists
incorporate their personal values into practice, but it is essential that they
recognize their influence on clients.
They cannot be the only source of value in the therapeutic relationship. Professional values reflect “knowledge and experiences
acquired through relationships with other professionals related to ethical
propriety, accepted practices, legal constraints, and even therapeutic tradition”.
This chapter discussed systemic
epistemology, different layers of values, and different forms of power. There are four basic propositions of the
systemic worldview. 1) Relationships are
the focus of study. 2) Relationships can be isolated for study and
defined. 3) Causation is circular within relationships. 4)
Therapeutic change occurs through social relationships. There are, however, certain views that
challenge this way of thought. The first
is the Feminist Critique. This view
challenged the field’s patriarchy and views on domestic violence. The second is the Self in the System. There has been an increasing desire to
develop models which bridge the gap between self and the system. Over time, there have been evolving
epistemologies. We should not be
choosing between a “theory of persons and a theory of persons in relationships”. The book recommends using a wide-angle lens
and being able to incorporate different theories into marriage and family
Since everyone holds a different
value system, it is important for practitioners to balance their personal
worldview with those of their clients and to have respect for cultural and
personal differences. This is called
value-sensitive care. As a therapist, it
is important to be continually self-aware and to examine what values we use in our
professional decisions. If we fail to
examine this, we may significantly hinder our ability to assist clients. We can “check vision” through continuing
education, consultation, supervision, and even our own therapy.
This chapter discussed the relevance
of 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 do
in our ethical, legal, and professional decisions. They are a reference point for these decisions
and they guide us in our actions. Our values
are influenced by our race, culture, class, religion, gender, and sexual orientation. The combination of these factors creates a
unique value structure for both therapists and clients.