Ethical Issues in Couples and Family Therapy

Ethical Issues in Couples and Family Therapy April 8, 2008 COUN 7885/8885 Steve Zanskas, Ph.D., CRC

Introduction • A paradigm shift… • Systems theory views psychological problems as arising from within the individual’s present environment and the intergenerational family system.

Introduction continued • The family systems perspective is grounded on the assumptions that a client’s problematic behavior may: • Serve a function or purpose for the family • Be a function of the family's inability to operate productively • Be a symptom of dysfunctional patterns handed down across generations.

Introduction continued • The family as a functioning entity that is more than the sum of its members. • Training programs include: • the study of systems theory • examination of family of origin • use of live supervision • an emphasis on ethical and professional issues specific to working with couples and families.

Ethical Standards in Couples and Family Therapy (AAMFT) • “Marriage and family therapists advance the welfare of families and individuals.” • The assumption…by agreeing to become involved in family therapy, the members can generally be expected to place a higher priority on the goals of the family as a unit than on their own personal goals.

Ethical Standards in Couples and Family Therapy (AAMFT) cont. • “Therapists respect and guard confidences of each individual client.” • How? • Treat all information received from a family member as if the person were in individual therapy. • Refuse to see any member of the family separately, claiming that doing so fosters unproductive alliances and promotes the keeping of secrets.

Ethical Standards in Couples and Family Therapy (AAMFT) cont. • Principle of professional competence and integrity implies: • Clinicians keep abreast of developments in the field through continuing education and clinical experiences. • The code concerning “responsibility to students and supervisees” cautions practitioners to avoid multiple relationships, which are likely to impair clinical judgment.

Ethical Standards in Couples and Family Therapy (AAMFT) cont. • Researchers must use informed consent procedures & explain to participants what is involved in any research project. • Ethical practice requires measures of accountability that meet professional standards. • Includes contributing time for the betterment of society • donating services

Ethical Standards in Couples and Family Therapy (AAMFT) cont. • Financial arrangements: • Couples and family therapists do not accept payment for making referrals and do not exploit clients financially for services. • They are truthful in representing facts to clients and to third parties regarding any services rendered. • Ethical practice dictates a disclosure of fee policies at the onset of therapy.

Ethical Standards in Couples and Family Therapy (AAMFT) cont. • Advertising: • Ethical practice dictates that practitioners accurately represent their • Competence • Education & training • Experience in couples and family therapy.

Special Considerations in Working with Couples/Families • The most commonly reported reasons for seeking couples therapy were problematic communication and lack of emotional affection. • Therapists need to consider that the status of one partner or family member does not improve at the expense of the other partner or another family member. • Therapists who function as an advocate of the system avoid becoming an agent of any one partner or family member.

What would you do? • The Divorce…

Personal Characteristics of the Family Therapist • Self-knowledge is critical for family therapists • Especially with regard to family-of-origin issues. • Assumed that trainees can benefit from an exploration of the dynamics of their own family of origin. • Clinical evidence supports a family-of-origin approach to supervision is a necessary dimension of training for therapists.

Educational Requirements for Family Therapy • Family therapy programs use three primary methods of training: • Didactic course work • Master therapist videotapes & trainee tapes for postsession viewing by the trainees and supervisors • Regular supervision by an experienced family supervisor who, together with trainees, may watch the session behind a one-way mirror or on videotape.

Educational Requirements for Family Therapy continued • Some of these include: • Gender awareness • Cultural sensitivity • An understanding of the impact of larger systems on family functioning

Experiential Qualifications for Family Therapy • Trainees develop their own styles of interacting with families through direct clinical contact with families & close supervision. • Supervisory methods include: • Audiotapes • Videotapes • Written process notes • Co-therapy • Corrective feedback by telephone • Live supervision including calling the trainee out of the family session for consultation

Experiential Qualifications for Family Therapy continued • Most graduate programs employ both didactic and experiential methods and supervised practice. • Didactic methods include lectures, group discussion, demonstrations, instructional videotapes of family therapy sessions, role playing, and assigned readings. • Experiential methods include both personal therapy and working with issues of one’s own family of origin.

Experiential Qualifications for Family Therapy continued • Family therapy trainees can also profit from the practice of co-therapy.

Values in Couples and Family Therapy • Values pertaining to marriage can influence therapists’ interventions. • The therapist’s value system influences • the formulation and definition of the problems • the goals and plans for therapy • the direction the therapy takes

Values in Couples and Family Therapy continued • According to Gladding et al. (2001): • the content of values is important, but they emphasize the process of valuing, which includes their values, beliefs, & actions • It is not the function of any therapist to make decisions for clients.

Values in Couples and Family Therapy continued • The role of the therapist is to help family members: • See more clearly what they are doing, • Make an honest evaluation of how well their present patterns are working for them, and • Encourage them to make necessary changes.

Gender-Sensitive Couples and Family Therapy • Try to help women and men move beyond stereotyped gender roles. • Our perception of gender is related to our cultural background. • Ethical practice is enhanced if therapists are aware of the history and impact of gender stereotyping as it is reflected in the socialization process in families.

Feminist Perspective on Family Therapy • Feminist therapists contend • clinical practice of family therapy has been filled with outdated patriarchal assumptions • grounded on a male-biased perspective of gender roles and gender-defined functions within the family • Feminist view focuse on gender and power in relationships and encourage a personal commitment to challenge gender inequity.

Feminist Perspective on Family Therapy • Feminist therapists challenge traditional gender roles and the impact this socialization has on a relationship and a family. • Feminist therapists advocate for definite change: • social structure • equality • power in relationships • the right to self-determination • freedom to pursue a career outside the home • the right to an education

A Nonsexist Perspective on Family Therapy • It is critical that family therapists take whatever steps are necessary to account for gender issues in their practice and to become nonsexist family therapists.

A Nonsexist Perspective on Family Therapy continued • According to Margolin (1982), family therapists are particularly vulnerable to the following biases: • assuming that remaining married would be the best choice for a woman • demonstrating less interest in a woman’s career than in a man’s career • encouraging couples to accept the belief that child rearing is solely the responsibility of the mother • showing a different reaction to a a wife’s affair than to a husband’s • giving more importance to satisfying the husband’s needs than to satisfying the wife’s needs

Responsibilities of Couples and Family Therapists • Legal obligations may require therapists to put the welfare of an individual over that of a relationship. • The law requires family therapists to inform authorities if they suspect child neglect or abuse or become aware of it during the course of therapy. • In cases of domestic violence: • Clinicians agree conducting couples therapy while there is ongoing domestic violence presents a potential danger to the abused & is unethical.

Confidentiality in Couples and Family Therapy • If therapists use any material from their practice in teaching, lecturing, and writing, they need to take care to preserve the anonymity of their clients. • When working with families, any release of information must be agreed to by all parties. • Exceptions to this policy: • when a therapist is concerned that a family member will harm him- or herself, or will do harm to another person. • when the law mandates a report.

Confidentiality in Couples & Family Therapy continued • Couples need to be frequently reminded of the “no secrets” policy. • ACA’s (2005) standard dealing with couples and family counseling states: • “Counselors seek agreement and document in writing such agreement among all involved parties having capacity to give consent concerning each individual’s right to confidentiality and any obligation to preserve the confidentiality of information known.”

Differing Views: Confidentiality & Family Therapy • Therapists should not divulge in a family session any information given to them by individuals in private sessions. • Reserve the right to bring up certain issues in a joint session. • Est. a policy of refusing to keep information secret that was shared individually. • Inform their clients that any information given to them during private sessions will be divulged as they see fit in accordance with the greatest benefit for the couple or the family.

Informed Consent in Couples & Family Therapy • Before each person agrees to participate in family therapy, it is essential that the counselor provide information about: • the purpose of therapy • typical procedures • risks of negative outcomes • possible benefits • fee structure • limits of confidentiality • rights and responsibilities of clients • the option that a family member can withdraw at any time • what can be expected from the therapist

Informed Consent in Couples & Family Therapy continued • Taking the time to obtain informed consent from everyone conveys the message that no one member is identified as the source of all the family’s problems. • In informed consent documents, it is essential that the therapist’s policy spell out conditions for family therapy to begin.

Informed Consent in Couples & Family Therapy continued • There is no professional agreement on whether it is necessary to see all the family for therapy to take place. • Corey, Corey, & Callanan (2007) believe it is particularly important when it comes to therapy with children. • Including the whole family in therapy • provides more protection for the child • as the family system corrects itself, the family can become a source of support for the child.

Ethical Issues in Couples and Family Therapy