Perspectives are worldviews which inevitably lead to competition and attempts to influence conditions and decisions that support those perspectives. MFTs practice in the contexts of these competing perspectives, which make up the ________.

Ecology of Therapy

2 dimensions of the ecology of therapy:

1. Layers of Values

2. Forms of Power

3 layers of values that influence contemporary mental health care:

1. Institutional Values

2. Personal Values

3. Professional Values

Various organizations affect therapists in their work with couples and families, including: (6)

a) Legal Systems

b) Managed Care Systems

c) Practice Settings

d) Medical Systems

e) Regulatory Bodies (e.g. licensure boards)

f) Delivery & Management Systems (e.g. tech-based systems)

Values of a system which typically involve codifying rules, standards of procedures, and even hierarchical recognition of professional and non-professional representatives; influence practitioners when they become an affiliate or representative.

Institutional Values

Values in which each of us has a worldview that is strongly influenced by acculturation, where we develop our identity to answer question “who am I?” by emphasizing or de-emphasizing characteristics and qualities we have come to embrace as significant or reject as unimportant.

• reflect our notions about right-wrong or good-bad distinctions
• sig aspects develop before becoming MFTs
• sig foundational elements for relationships w/ clients, peers, and institutions

Personal Values

Values which reflect knowledge and experiences acquired through relationships with other professionals related to ethical propriety, accepted practices, legal constraints, and even therapeutic tradition.

Professional Values

A professional worldview emerges in much the same way as does a personal worldview, where both are: (3)

1. strongly influenced in mentoring relationships

2. continually developing as MFTs are faced w/ professional and social issues that require renewed examination of their personal and professional

3. emerge and develop based on shared values especially toward clients, professional peers, and self-policing

Values are demonstrated in our attempts to influence others or affect situations to gain outcomes that support our values. We act using various forms of power to convey our values and to influence others: (3)

1. Legitimate Power

2. Referent Power

3. Expert Power

Form of power found in hierarchical structures; those in positions of employment, management, or enforcement can exercise such power to require certain behaviors of subordinates in that hierarchy.

Exists in governmental, legal, and commercial systems in which the institutional values of standardization and conformity are required through reward, advancement, threat, intimidation, or even force.

Legitimate Power

Form of power to influence that is non-coercive and highly personalized; the most personal and compelling means of influence. Grounded in qualities such as admiration, attractiveness, or veneration, and conferred by observers rather than imposed.

Referent Power

Form of power in which the capacity to influence is based on experience, knowledge skills, and competence; Granted by others who are convinced that those who hold such a role in their lives are knowledgeable, skilled, reliable, and trustworthy.

Can promote confidence of others in one’s judgment and abilities, and is the basis for a therapist’s credibility w/ clients and peers.

Expert Power

The sources of power often converge with layers of value as couplets, which is unique for each person, particularly in their effect on personal acculturation and worldview. For example, legitimate power often supports ________. Similarly, referent power can strongly influence ________.

• Institutional Values
• Personal Values

Process which occurs after one has developed a worldview based on personal acculturation, involving the effect of professional values-expert power couplet on one’s existing worldview.

Professional Acculturation

Identify the 5 foundational principles which guide the translation of a “good theory” into decisions on behalf of client welfare, and occurring within the ecology of therapy:

1. Autonomy

2. Beneficence

3. Nonmaleficence

4. Justice

5. Fidelity

Principle that all human beings have the right to make decisions and act on them in an independent fashion.

Autonomy

Principle that one must actively attempt to benefit another in a positive manner

Beneficence

Principle that one must avoid causing harm to another

Nonmaleficence

Principle that all individuals should be treated fairly; equals treated as equals, and unequals treated in a way most beneficial to their specific circumstances.

Justice

Principle of commitment to keep promises, uphold the truth, and maintain loyalty.

Fidelity

Even with the best of intentions, ethical practice is a balance of risk and choice.  Some ethical concerns can be addressed by simply following the prescribed ____________, where risk and choice are minimized in favor of tradition and increased certainty.

By contrast, some concerns pose dilemmas with greater choice and accompanying risk. Resolving these dilemmas requires interpreting foundational ethical principles for ___________ by therapists.

• Mandatory Actions (obligatory/prohibited)
• Discretionary Actions

Code of Ethics aid professionals in dealing with potential dangers from 3 groups:

1. Government

2. Professionals

3. Public

All professions desire autonomy and seek to avoid undue interference and regulations by lawmakers. Therefore, codes of ethics are designed to protect the profession from the government by…

…asserting a self-regulatory stance. (institutional value-legitimate power couplet)

Codes of ethics enables professionals to live in harmony by offering protection from potential…

• For example, it is unethical to entice colleagues’ clients to leave them.

… self-destruction occasioned by internal discord in the absence of such areas as common agreement. (institutional value-legitimate power couplet)

Codes of ethics protect professionals from the public by…

Each ethical standard reflects some element of the foundational ethical principles. Some code statements are definitive, institutionalizing professional values and including legitimate power of professions to discipline colleagues.

These types of standards concern mandatory actions or either: (2)

1. Prohibition (i.e. no sexual contact)

2. Obligation (i.e. maintaining awareness of personal values)

Mandatory actions are primarily designed to accomplish the principle of ________, which may or may not result in beneficence, or doing good for the client.

Nonmaleficence

It is in the area of discretionary actions that the professional acculturation of the therapist appears most critical to client welfare, in which decisions are made that are either aspirational or virtuous in nature. 2 principles are of critical concern:

1. Nonmaleficence

2. Beneficence

The ethical responsibility required of all national counseling organizations and some state licensing boards that nothing disclosed w/in the counseling session will be revealed to another person w/out the client’s expressed consent; often referred to as the “cornerstone of ethics.”

• Has become intertwined w/ legal constraints dictated by state and federal legislation and court decisions regarding privileged communication and privacy.

Confidentiality

2 reasons for maintaining confidentiality in psychotherapy:

1. Protects clients from the social stigma frequently associated with therapy

2. Promotes vital client rights, integral to therapists’ professed concern for client welfare

From the perspective of the legal system, confidentiality is generally viewed as an exception to the principle that…

…all relevant information should be available to judicial decision makers.

4 Exceptions to Confidentiality:

1. When client determined danger to self/others

2. Requests info release to third party

3. Child abuse/neglect is suspected from info learned

4. Court order release of confidential info

Always talk to an attorney before breaking confidentiality!!!!!!!!!!

State and federal legislation, as well as court decisions, have increasingly mandated disclosure of information in certain situations, most notable in instances of ________________.

Child or Elder Abuse/Neglect

Legal exceptions to maintaining confidentiality represent institutional values that are supported by legitimate power to demand disclosures or impose penalties.

Thus, a thorough understanding of the limits of confidentiality in the therapeutic relationship prior to or at the beginning of therapy is a(n): (2)

1. Mandatory Duty

2. Essential Element of Due Care

To the extent allowed in legislation and legal precedents, clients are typically afforded the right to consent in regulating the disclosure of confidential information in a therapy relationship.

This situation is particularly compelling in applying the ethical precept of confidentiality when imposed w/ legal attempts to offset this cornerstone of psychological care. In such cases, _________ is a sig. consideration for therapists.

Privileged Communication

A legal right which exists by statute and which protects clients from having their confidences revealed publicly from the witness stand and during legal proceedings w/out their permission.

Privileged Communication

Where privileged communication laws apply, therapists are prevented from testifying in court about clients w/out their consent unless the client waives this privilege. This is because the privilege: (2)

1. Belongs to the client

2. Is meant for the protection of the client, not therapist

Essentially, privileged communication is the application of the ethical notion of confidentiality in a legal forum. It is important to note that privileged communication for the therapist-client relationship: (2)

1. Is not legally supported in all states

2. Can be subject to exceptions

Even when clients have not waived their right, privileged communication can be subject to exceptions such as when: (3)

1. one has been appointed by the court to secure information

2. one must defend against client allegations

3. criminality or matters of protection are involved

The freedom of individuals to choose for themselves the time and the circumstances under which the extent to which their beliefs, behavior, and opinions are to be shared or withheld from others.

• The concept is addressed by the 4^th Amendment to the U.S. Constitution, protecting one’s home against illegal search and seizure.

Privacy

The concept of privacy not only deals w/ communications, but also relates to: (8)

1. Disposal of records

2. Not being identified in a waiting room

3. Tape recordings

4. Use of credit cards for billing

5. Use of computer services for scoring tests or billing

6. Other documentary or business activities

7. Professional consultation

8. Supervision

Issues of privacy are particularly important when: (2)

1. Managed care agencies and other third-party payers attempt to gain access to therapy information

2. Therapists are bound by the law and/or professional codes of ethics to break confidentiality

Therapists should maintain a current record of third-party reimbursement requirements (i.e. insurance) in order to apprise clients of: (2)

1. The kinds of information that will need to be released (i.e. diagnostic labels)

2. Who may have access to the information

A curious tension has evolved in terms of privacy concerns for clients and the institutional procedures that involve technology.

As an overarching principle, professional values for the MFT…

By contrast, an overarching principle of institutional values for those employing technological adjuncts to therapy and case management is…

…respect for client privacy.

…access to and exchange of private client information.

In some governmental agencies and institutions, the therapist is not primarily the client’s agent. In these situations, therapists are faced with acculturation conflicts between: (2)

1. Professional Obligations to Clients

2. Institutional Obligations to Agency or Work Setting

Therapists may encounter circumstances in which compelling legal precedents overwhelm considerations of confidentiality and privacy.  Such is the case in instances in which therapist have a ___________, a position adopted by professional organizations involved with the practice of psychotherapy in which certain information must be revealed when there is clear and imminent danger to an individual or society.

Duty to Protect

Tarasoff: 3 factors creating a duty to protect for therapist: (p. 204-205)

1. Special relationship

2. Reasonable prediction of conduct that constituted a threat

3. Foreseeable victim

Psychotherapists are not liable for failure to warn when the propensity toward violence is: (2)

1. Unknown

2. Would be unknown by other psychotherapists using ordinary skill

Set of procedures for therapists to follow if they determine that a client poses a serious danger of violence toward others: (6)

1. Inform clients of possible action they must take to protect third party in situations in which violence may be inflicted

2. Document everything observed and stated in session when client makes threats against others

3. Inform supervisor in writing of any serious threat

4. Consult with colleagues qualified to offer opinions on how to proceed and document

5. Alert police and other proper authorities

6. Notify intended victim; in case of minor, notify parents as well

Although a therapist, a person is still a citizen and they must protect and contribute to the common good. Therefore, a person of good conscience will not hesitate to warn and intended victim, or to prevent the continuation of child abuse, incest, or other forms of violence.

These are not matters of discretion and virtue. Rather, they are matters of mandatory action reflecting professional values for: (2)

1. Nonmaleficience

2. Justice

Information given to clients in a package that includes an acknowledgement sheet that can be signed and returned to the therapist, containing information in order to assure that clients are adequately informed of their rights and responsibilities within therapy. Includes info about

• what will be expected of them, 
• what they may expect from the therapist and therapy, 
• what their rights as clients are 

Informed Consent 

Informed Consent is designed to: (4)

1. Reflect the intentionality of the therapist

2. Provide a process of structure about mutual expectations in therapy process

3. Address issues related to financial obligations, scheduling, documentation & records, etc.

4. Establish an expectation that clients or consumers will be notifies of all actions related to disclosures of confidential information in therapy

3 types of information clients should have in order to make informed choices about entering into and continuing therapy:

1. Procedures, Goals, and possible Side Effects of therapy

2. Qualifications, Policies, and Practices of the therapist

3. Other available Sources of Help

Most therapists who recognize the need to educate clients about their rights and responsibilities employ some form of written document to introduce and record the implied contract that consent for treatment represent.

2 such types of written communication are:

1. Therapeutic Contract

2. Professional Disclosure Statement

Purpose of this document is to clarify the therapeutic relationship by defining therapy as a mutual endeavor to which therapists contribute their professional knowledge and skills and clients bring a commitment to work; encourages all parties to specify relevant goals, expectations, and boundaries, and considers such issues as

• Specific therapeutic approach and procedures
• Length and frequency of sessions
• Duration of treatment
• Cost & method of payment
• Provisions for cancellation/renegotiation of contract
• Extent of each party’s responsibilities
• Degree of confidentiality

Therapeutic Contract

Document which entails a process of introducing prospective clients to a therapists’ qualifications, the nature of the therapy process, and administrative procedures relating to time and money.

• Clarifies aspects of one’s professional values related to worldview, practices, and professional acculturation by defining a set of competencies and an approach to identifying them as unique providers of beneficial human services.

Professional Disclosure Statements

Multiple clients in MFT can create dilemmas for therapists in that: (3)

1. An intervention that serves one member’s best interest may be counter-therapeutic to another

2. Inequalities of power and rights also become matters across household generations

3. External agencies affecting the ecology of therapy become matters of institutional values affecting clients and therapists

3 ethical principles can converge to create significant difficulties when serving multiple clients:

1. Autonomy

2. Beneficence

3. Justice

MFTs assume complex responsibility for judgments about the welfare of more than one individual. Equally significant in such judgments is the effect of institutional values that may require the therapist to “pathologize” an individual member in order to permit services.

In such situations, the ethical principle of _____ must be considered.

The therapist can respond to this dilemma of conflicting interests by…

Justice

…identifying the marital or family system rather than a single individual as the “client”

Various ethical codes address the issues of identity, rights, and service to multiple clients, stating that when psychologists agree to provide services to several persons who have a relationship, they must take reasonable steps to clarify at the outset: (4)

1. Expectations and limitations of confidentiality w/ each individual

2. Which individuals are identified as the primary clients

3. Relationship the psychologist will have w/ each person

4. Obligations to an individual, couple, family, 3^rd party, or institution

For system advocates, the complex nature of managing decisions and attempting outcomes for multiple clients means that due care often…

…goes beyond the specific and sometimes self-centered goals of individual members.

Multiple clients create multiple considerations for practitioners, and establishing clients’ rights and authority is critical at the outset of therapy. These rights begin with ____________.

Confidentiality

MFTs must not only inform clients in individual therapy of the limits of confidentiality, but have an additional obligation toward marital partners or other family members: They must decide what confidentiality means for the couple or family group, and how it will be maintained.

Generally, when dealing w/ multiple clients,  issues of confidentiality that are unique to MFT are in 2 areas:

1. Secrets

2. Changes from systemic to individual formats

Families tend to have 3 types of secrets:

1. Shared family secrets

2. Internal family secrets

3. Individual secrets

Family secrets tend to fall into 3 different types of categories:

1. Taboo Topics

2. Rule Violations

3. Conventional Secrets

The 2 major issues impacted by having more than one client in the room are:

1. Confidentiality (Legal/Ethical; but mostly Legal)

2. Secrecy (Ethical)

In regards to confidentiality issues with multiple clients, some have advocated a distinction between secrecy and privacy in terms of…

An incident which is now reasonably resolved and not significantly affecting the present relationship (e.g. childhood trauma), would be considered _______.

• A client may at some time choose to share this history with members, but does not owe it to them to do so.

Private

Withholding of information that involves deception as well as a violation of trust would be considered ________.

Secret

Confidentiality obligations are complicated when a change in the format of therapy takes place from individual therapy to the inclusion of a partner, spouse, or other family members.

2 critical issues to address when considering such a change include:

1. How the therapist should handle the info obtained during individual therapy; may/may not receive permission to share

2. Even if client permits info to be shared, permission granted after info was obtained; client may not remember all that was confided

The application of confidentiality in the legal sphere is subject to the state laws concerning ________.

Privileged Communication

As one considers the application of confidentiality and its derivatives (i.e. privacy, privileged communication, and duty to protect), it becomes apparent that therapists must be deliberate in clarifying circumstances and expectations for discloses to other family members or those outside the therapy system.

Clients have fundamental rights to regulate information relevant to their welfare and to clarify their expectations for therapy. Such information is addressed through procedures of ________.

Informed Consent

Terms which emerged in the professional literature as descriptors of chronic and episodic patterns of abuse, ranging from harsh criticism to aggressive brutality, between adults in intimate relationships.

• Unlike other forms of aggression, it often features the unfortunate yet compelling elements of intergenerational and gender-specific traditions promoted w/in a family or a community.

Intimate Partner/Domestic Violence

Intimate partner violence includes 3 forms of victimization:

1. Adult Partner Abuse

2. Child Abuse

3. Elder/Dependent Abuse

Acts such as Child Abuse and Elder Abuse are actually forms of domestic violence, though they are typically distinguished in ________ and ________ legal mandates that compel action on the part of therapists in order to protect those who may be unable to protect themselves.

• The distinction has been a myth of equality.

• Duty to Warn
• Duty to Protect

Physical injury or death inflicted by other than accidental means upon a child by another person, sexual abuse, neglect, willful harming or injury of a child or endangering of the child’s person, health and unlawful corporal punishment or injury. 

Does NOT include a mutual affray between minors, an injury caused by reasonable and necessary force by a peace officer acting within the course and scope of his/her employment  as a peace officer.

Child Abuse

7 Common indicators of Child Abuse:

1. Unexplained Burns
2. Cuts
3. Bruises
4. Unsuitable clothing for weather
5. Extreme Hunger
6. Fear of Adults
7. Sexual knowledge beyond years

A person between the ages of 18 years and 64 who has physical, mental or financial limitations which restrict his/her ability to carry out normal activities of daily living, ability to protect his/her rights, and which threatens the individual’s capacity  to live independently

Dependent Adult

Any person 65 years or older.

Elder Adult

Knowledge or reasonable suspicion of an incident of:

• Physical Abuse – injury inflicted upon an elder or dependent adult by another, by other than accidental means. 
• Includes the use of physical, chemical restraint or psychotropic medication, and withholding by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering. 
• May involve abandonment, isolation, neglect, financial abuse, and abduction.

Elder/Dependent Adult Abuse

A mandated reporter has no obligation to investigate a known or suspected incident of elder/dependent adult abuse.

In examining the Limitations on the Duty to Report Dependent/Elder Adult Abuse, all of the following 4 conditions must exist:

1. The elder/dependent adult has told a therapist they have experienced a form of mandated abuse.

2. The mandated reporter has no evidence of this abuse.

3.The elder/dependent adult has a diagnosis of: Dementia, defect or incapacity or is under court ordered conservatorship because of the above conditions.

4. The therapist believes abuse did not occur.

Any person under the age of 18 years is an Emancipated Minor if any of the following conditions is satisfied: (3+3)

1. Entered into a valid marriage, whether or not the marriage has been dissolved.

2. Is on active duty with the armed forces of the U.S.

3. Has received a declaration of emancipation from the court stating that s/he is:

            a) at least 14 years of age

            b) willingly living separately from parents w/ their consent 

            c) managing financial affairs (no illegal income)

Under the exception clause, minors can enter into treatment w/out parental consent under 6 conditions:

1. 12 years of age or older

2. Counseling is on an outpatient basis

3. Must be mature enough to participate intelligently in treatment

4. Good reason why involvement of the parents would not be appropriate

5. Would present danger orserious physical/mental harm to self/others w/out Tx

6. Has been the alleged victim of incest, child abuse, or rape

The purpose of the Juvenile Court is to provide for the protection and safety of the public and each minor under the jurisdiction of the court, as well as: (5)

1. to preserve and strengthen the minors family, removing them from custody only when necessary for minor’s welfare or safety and protection of public

2. an order to be a ward of the court is NOT indication of a crime conviction, nor is the proceeding deemed a criminal proceeding

3. court can declare a child a dependent child of the court and conduct a dependency hearing to determine custody

4. may appoint counsel for the child when it appears the parent/guardian desires counsel for the child but is not financially able to afford it

5. may appoint advocate for the interest of the child (same duties and responsibilities as guardian)

3 dimensions of domestic violence identified as the basis for distinguishing subtypes of offenders:

1. Severity of Violence

          -(e.g. shoving, severe brutality)

2. Generality of Violence

          -(i.e. violence toward partner or toward others)

3. Presence/Absence of Psychopathology/Personality Disorders

Discussions of the origins of domestic violence consider co-occurring or contributing factors/conditions, both psychological/experiential and environmental in nature, that may promote or sustain such patterns, including a history of: (5)

a) Physical Abuse

b) Psychological Maltreatment

c) Sexual Abuse

d) Neglect

e) Witnessing Violence

Competence in online care also requires attention to….

Due care in both the content and format of cybertherapy is a reasonable expectation of clients who must place their trust in the practitioner and the medium.

Thus, clients should be assured of the online therapists’: (2)

1. Technical Ability

2. Therapeutic Skills

For purposes of informed consent about practice competency, therapists may even encourage online clients to verify their credentials with: (3)

1. Licensure Boards

2. Certification Bodies

3. Other Professional Agencies

The issues of informed consent are equivalent in face-to-face therapy and online therapy. However…

The spread of AIDS has given rise to questions regarding the limits of confidentiality within the therapeutic relationship. Namely, the question is…

Do MFTs have a duty to warn a potential victim when a client discloses that he/she has tested positive and has an identifiable sexual or needle-sharing partner who is unaware of the infection?

Therapists do not have a duty to warn because

• they must first prove the client has HIV through medical documentation of the diagnosis AND
• have identified a specific intended victim.

6 step framework for understanding the process of a client deciding whether to disclose HIV status to family members as well as the interventions to be used:

1. Accepting & Adjusting to Diagnosis 

          -(info & educ)

2. Evaluating Personal Disclosure Skills 

          -(emphasis on pros, cons, difficulties, strategies)

3. Taking Inventory of Who Should be Told 

          -(highlighting issue of family boundaries)

4. Evaluating Potential Recipients' Circumstances, such as health/age      

          -(addressing guilt, anxiety, sadness for telling some members)

          -(developing plans for disclosure)

5. Anticipating Reactions of Recipients, such as anger/support

          -(clarification of possible reactions)

6. Motivation for Disclosure, such as desire for support/obligation

          -(defining personal needs & identifying family members to meet needs)

A more legally oriented ethical approach to dealing with HIV-positive clients  proposes that the ethical dilemma involving therapists' obligations to their clients and third parties relative to AIDS bears an apparent resemblance to the question regarding...

The question of what to do in circumstances such as the ethical dilemma of  obligation to clients vs third parties relative to AIDS is answered in the Tarasoff decision which states that confidentiality within psychotherapy is to be highly values, but never regarded as absolute.

Therapists' obligations to the patient require that he/she: (2)

1. Not disclose a confidence unless necessary to avert danger to others

2. Do so discreetly and in a fashion that preserves the privacy of the patient to the fullest extent compatible with the prevention of a threatened danger

4 relevant ethical factors therapists must consider regarding disclosure:

Therapists dealing with confidentiality in an AIDS-related therapeutic situation are encouraged to employ 3 criteria resulting from Tarasoff, requiring a:

1. Fiduciary Relationship
2. Identifiability of a Victim
3. Forseeability of Danger

A relationship of special trust present between therapist and clients; inherent when therapist agrees to work with a client, thereby assuming special responsibilities for the client's behavior that are not part of everyday relationships.

Fiduciary Relationship

Regarding HIV-positive clients, states that the duty to protect extends only to recognizable victims and not to all persons whom a client could potentially harm, such as sexual or needle-sharing partners.

Does NOT necessarily extend to casual sexual or drug partners unless they were readily identified.

Identifiablity

States that the danger must be predictable before the duty to protect is invoked; most difficult to ascertain for therapists working with HIV-positive clients.

Foreseeability

Foreseeability is the most difficult to ascertain for therapists working with HIV-positive clients. Knapp and VandeCreek (1990) offered direction in classifying 3 types of behaviors influencing therapists duty to protect:

1. Low-Risk
2. High-Risk
3. Intermediate Risk

Behaviors that do not appear to give rise to a duty to protect, as evidence suggests that HIV infection cannot occur through food, tears, urine, or insect bites. 

ex) casual non-sexual contact, living together

Low-Risk

Behaviors that clearly give rise to a duty to protect, the presence of which should be assessed in the context of establishing and enhancing a therapeutic relationship because the primary goal of psychotherapeutic efforts is to empower clients to be responsible for own well-being and that of another.

ex) unprotected sexual contacts and sharing of needles which are the primary modes of HIV transmission

High-Risk

Behaviors for which the duty to protect may be present, but the foreseeability of danger to others is less apparent.

ex) "safe sex" w/out informing partners of their infection

Intermediate-Risk

Depending on the level of risk for transmission, clients' voluntary disclosure of their HIV status should be a more or less immediate focus in therapy.

In making a final determination, factors that must be taken into account include the client's: (3)

11 subprinciples of Principle 1: Responsibility to Clients state that MFTs:

PIASS RUR BOA

1.1   provide professional assistance to persons w/out discrimination

1.2   obtain informed consent to therapy/procedures as early as feasible in clients language

1.3   are aware of their influential positions w/ clients and avoid exploiting client trust/dependency

1.4   sexual intimacy w/ clients is prohibited

1.5   sexual intimacy w/ clients is likely harmful and prohibited for 2 years following termination of therapy

1.6   comply w/ laws regarding reporting of alleged unethical conduct

1.7   do NOT use professional relationships w/ clients to further own interests

1.8    respect the rights of clients to make decisions and help them to understand consequences

1.9    continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting

1.10  assist persons in obtaining other therapeutic services if therapist is unable or unwilling

1.11  do NOT abandon/neglect clients in treatment w/out making reasonable arrangements for continuation 

The practice of marriage and family therapy shall mean that service performed with individuals, couples or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying and productive marriage and family adjustments”.

• This  practice includes relationship and pre-marriage counseling.

MFT Scope of License

The application of marriage and family therapy principles and methods include , but is not limited to,

• the use of applied psychotherapeutic techniques to enable individuals to mature and grow within marriage and the family, 
• the provision of explanations and integration of the coursework and training required by Sections 4980.36,4980.37 and 4980.41

MFT Scope of Practice

2 legal frames of reference in which an MFT can operate:

1. Scope of License

          -(reference to law; what can/cannot do)

2. Scope of Competence

          -(reference to education)

In regards to confidentiality, if a client enters therapy agitated because a co-worker called him, stating he has a gun and talking about getting even with their boss, is there a duty to warn? Why or why  not?

No, the therapist must maintain confidentiality because

• we don’t report 3^rd party information (must be face-to-face) and 
• the client is not a danger
• instead the therapist should encourage the client to take action.

T/F: One exception to duty to protect is either a special relationship with the one whose behavior needs to be controlled or with the identifiable victim.                                                        

True

T/F: All states require reporting of child abuse to authorities, particularly if physical            

True

T/F: As a referral resource, MFTs are used by courts for information and interventions         

True

T/F: The primary function of MFTs in Juvenile System is to provide diagnostic evaluation for rehabilitative services   

True

T/F: If HIV infected clients tells you, and has identifiable victim, must report                                  

False

Principle 1: Responsibility to Clients (Case 1)

A female client had been seeing a male MFT for over a year to resolve issues emanating from her divorce. When sexual desires btw her and the therapist were conveyed and acted on, the therapist immediately terminated the therapeutic relationship. No referral was recommended, nor was time spent addressing the termination.

They continued a socially & sexually intimate relationship for 6 months. The woman broke off the relationship when she began to experience the same emotional difficulties that originally led her to initiate therapy following her divorce.

6 subprinciples that come into consideration in this case:

1.3  MFTs are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons by avoiding conditions/multiple relationships w/ clients that could impair judgment or increase risk of exploitation.

1.4  Sexual intimacy w/ clients is prohibited

1.5  Sexual intimacy w/ clients is likely harmful and therefore prohibited for 2 years following termination of therapy

1.9   MFTs continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting

1.10 MFTs assist persons in obtaining other therapeutic services if therapist is unable or unwilling, for appropriate reasons, to provide professional help

1.11 MFTs do not abandon or neglect clients in treatment w/out making reasonable arrangements for continuation of such treatment

Principle 1: Responsibility to Clients (Case 1)

A female client had been seeing a male MFT for over a year to resolve issues emanating from her divorce. When sexual desires btw her and the therapist were conveyed and acted on, the therapist immediately terminated the therapeutic relationship. No referral was recommended, nor was time spent addressing the termination.

The therapist was correct in terminating the therapeutic relationship, but: (4)

1. By not assisting the client to obtain other therapeutic services when no longer able, he abandoned client therapeutically.

2. At the very least, therapist could have provided a list of resources to be mailed or discussed with client

3. Therapist’s lack of cognizance relative to the influence he had with client is a serious ethical violation, suggesting an exploitation of clients vulnerable position

4. Issue of sexual intimacy is a flagrant ethical violation, as was therapists use of his professional position to advance his sexual interests

5 major steps for handling complaints of unethical behavior by AAMFT members:

I.    Initial Determinations

II.   Investigation

III.  Ethics Committee Action

IV.  Review by Judicial Committee

V.   Appeal to the Board

Substeps 1-3 in Step I: Initial Determination of unethical behavior by AAAMFT members:

1a. Complaint + 1b. Information Received →

2.   Membership Determination →

3a. Close  -  3b. Chair Determination  - 3c. Chair Determination (if can’t) →

(decision moves to Ethics Committee)

Substeps 4-7 in Step II: Investigation of unethical behavior by AAAMFT members:

4a. Close – 4b. Open Case (if open) →

5a. Insufficient Information → 6. Continue Investigation → 7. Ethics Committee Deliberation

OR

5b. Sufficient Information → 7. Ethics Committee Deliberation

Substeps 8-10 in Step III: Ethics Committee Action of unethical behavior by AAAMFT members:

8a. Close – 8b. Insufficient Information

OR

8c. Violation Found → 9a. Mutual Settlement

OR

9b. Recommended Action →

10a. No Review – 10b. Review (member requests Judicial Committee review)

Substeps 11-13 in Step IV: Review by Judicial Committee of unethical behavior by AAAMFT members:

11. Hearing →

12 a. Close OR 12b. Violation Found →

13a. No Appeal – 13b. Appeal (member appeals to Board of Directors)

Substeps 14-15 in Step V: Appeal to the Board regarding unethical behavior by AAAMFT members:

14. Appeal (board reviews info) →

15a. Upholds Judicial Committee Decision 

OR

15b. Remands to Judicial Committee (board finds procedures were violated and orders new hearing)