cHlPrER| - SusPsNoRrsl-l - 1.6
Pnnorul: Suammpusl.l rxnouon1.6 Rrspolsrerurv ro Gmns G.rgo.t Bt!d(, th.D,
Sedingclientsneedsandprolectinglhet intercslsis thefoundotion onwhkh lheinlqily of lhe qofessionof nn iogeondfotuilythercpy Iesfs.It is no dccidentthotrcsponsidw b clientscomesfrrsiomong t,]@eightVinciplesmokingup tlrF'AAMF|Codeof Elhics. Pn orr I REeoaasrs|jrr to G.6rs lilfii€p ar|d fon*y lh€lqeb odng|C3fi|e wdfur€ of {ornn6 ond hfridrds, fl|ey .€.p€d lta dgttt5of flrc€ p€r3or|3s€€ldnglkir osisllnce and m*e r€oson(|bleefiod! io €|ls'r lhot |||€? s€rvies ds rn€d e,|!p.hlr.*t l.l lrdioge qtd ffiy ltEJlpldB portd. p.lt€5co||ol oainlnce to p€tsota sithod &dffiiq|lon on tho bo* of l!Ge, oge dhridly, 3odo€@mmlc dqt t &dny. gqNder.h€dlh.ffit 3, .€Igloq nqliord odgin or 3€xud orbnldlion, YIGNETTE: An MFT ws nw$ hnedby a fmily thehpy ageny vh@ .lidts w@ alloored to clhicias dEougha .entralizedintakeplocedue. As the oDly Afti@ Americantherapiston sta4 tlis thmpisls 6.1@d v6 comptisedof ,I of the Afticd Amdi@ couple dd fMilies bas€don the long-standing notion *nt tlse dienrs wuld fed morc corforteble vith d Afticd Am€risn MFL AT 1 staff metin& dte theepist aised a conern about this ptactice si4ce it had @dated , miting list ficr tlese climti The theFpist {6 told by the director, vho *as also the sup€sisor, that clients' ne€ds crne ftst md thar the policy voutd remain in effecr OdEr staff agr€ed.They seid they would nor seeAfricm bv e Aflicm Amen@ Ameri@n didts becas€ those dients vere b6t *ftd
I
II I
UstR'sGUrDE TorHEMMFT CoDroFEfttcs
theepist. The drer2Fjs estded md r'ted a conplai't vith the Srate Civit Rights Boa.d, rhe state RegulatoryBo&d dd the AAMFT Erhics Commitrec. COMMENTS: D;cimiqarion takes nmy forms and as nmtzt health soice pi@iders, MFTS are resFoDsiblefor rccognizing, avoiding, dd duqiflg both bja, tant and de facto dis(imination pnctices. In ihis instance,ile inrdtions of agency staff dd aalministztors crexred 2 situatioo wheie some clents wde wait-listed (deprived of servi.et becaue of th€ii race.Urderlying rhis inrent v€re the racist md unfouded ssumpbons that all clidts p.efe( a th€€pst of the sme 6ce md that client pref€reocefor rhe hce of rhen $depist is th€ most import2lt crire.ion io predicting .ase outcome. 1.2 Monlog€ ond f.mly lherop&ts oblaln opp.opdoia innom€d cons€.rt to lheropy o. .doled Foc€dures 03 €drly os feosbl€ h fhe fite.qpedk r€lollonship, ond us6 longuoge tt|at b €osonobt und€lstondoble fo cfienls. th€ cofiisr* of irfoflmd conseit moy v.ry d€p€n&tg rrpon tfie .l€r$ dtd lredtrr|€nt pbt; ho$€d€r. inbfi€d co.tsent g€n€r.ly n€c€ciEes tfiat the cf€ni (o) hos the copo.ity fo con5ent lbl ho3 been od€quoHy inionned ol * ificqni Intom|alion conc.mtE treohto.f pocess€s ond poc€drn€6, G hos b€€i odequol€ly infonhed of pot€nfiol rid6 ord b€nefih of trBoftn€||ts for whkfi genelllly .€cogn'zed sliqndod3 do not y€f e*t (d) hos ||€dy ord without undue Infiu€nce elor€3r€d cons€nt qd tel hos prcddod @nset|f lhol b oppropftrtely doirfiEnH. wh€n p€Goos, due fo ogp or |'E|rld sbui, or€ hgolly lncopobh ot glvhg irlbrmed consent, rnorriog€.rd fonfy th€roplsls ob,qh intonned pennidoo from o hgElv outhorLed persorl it srdr subslihrte cons€nt ls legdy p€rmiliblo. VIGNETTE (a, e): A di@rced prdt etled a rhqapist for help with a middle school aged chnd. In the initi,l session,rhe prenr complained about diffc@t rrnes in th€ ex spouse'shome ud rhat the chnd rcruned froE visitations actins dFre,pecrrulivdd,(drel) fighdng ry rcque\t ro help,oMd th€ home Th; peent signed a th€npy agreeheot and said the custody dengem€nt permitted either pdent to seekmedical treatrnent for the child. Aft€r a second sessioo,rhe dlerapist decided to seethe child.lone for severalsessionsto lern dE childt view of the relationship between rhe prdts. \then the child told the ex spouse2bout dre therapy sessions,this p6on c,Ied the &trapist dd asserredthar $e child was not ro be seenatone or eirh fyoqe etse.Th€ ex spolse stzted dnr cusrody v6 nor ioi.t, that the the.apisr had im, propaly seenthe chnd withour the proper pdmissioD, ad that a complai't would
CruPnRI - fuBPRrNotuts l.l
COMMENTS (e" e): Id this inst nce, th€ $dapist did not chcck to dctermi.e whedld ft inibating pdent had the right to se€k therapy either for or vith the chnd. Best practice in thn situatioD would have requircd a review of ille achsl disrce dedee or other legal document that d€scribedthe custody setdement,dd keeping a file copy of rhat docmenL Eng,ging borl edults in the theepy from thc outs€t may also hare rcsolved the custody quesnonwhile involving thd i. the
Sone iuisdicdons stipulate the nmber of sessionsa ninor may be seenwithout prdt l permission (9?icaly only 1 or 2 md possibly only ro d€termioe rhe narure of rhe ch dt concemq consult you local statutet. Also some iurisdictions pernit minors to provide @Nent for v6y specific pr€s€nting prcbl€ms (e-9, drug abus, adol€sc€ntpt€cnarcy, s€x abuse). VIGNETTE (b): A couple ws in rhe secondof six contEctcd sessionsof tr€atment wh€n then rherapist stated that in two we€ks th€y would oeed to sp€od the e€ekend oo a retret corducred by a col€ague in the ag€ncy.For two we€ks fol lNing the rcttear coojoi.t s€ssionswould be suspendedto permit them tine to inlegFte nw behavioF iqto th€i! relationsbjp. The couple was sx+rised rd dis' m2yed that they v€r€ .ot told of &ese *rangements whd dEy besd t}ldapy. Their hmily life would not pemit extendedabsencedd they qucstioncd the rime off ftom sessions.They wonder€d vhether the ret!€at and the l4psein r€atment se.ved as cover vhile rhen thempisr hmdled some ag6cy €mqg€ncy or vent on veation ot €kn eqt€r€d drug abus€tream€nt, od they lodged a complaiot. COMMENTS (b): In deterdinhg vhether a &etuent wil 6t &en needs,cndts need to know vhat vi happd o€ $e couse of teatrndt th2t m2y sne as a basis for rei€ctiog th€ trcataeot In this instaDcea chdge in the schedulc p!€ wnted the couple &om attending contracted sessioDs.Had th€y known of the chdges, they my have souAht mother th€npist. YIGNETTE (c): After six mon$s of votk vith a fdily in weekly se$ioqs, the thenpist conduded dlat the fdily Ms wo6e off * a direct ftsult of teathent. Atl of the dscssments showeda broad baseddeieriontion in both fmily sffuctse dd p.ocess.This outcome ws disappoioting to the therapist who had invcsrcd io €xpensiv€ tai.ing for a pomisiog €xperim€nral $camlenq hoping to nurtue a struggling pnctice. Since the tteatment lrc applied outside th€ awa.en€ssof the f.mily mmberE no bention *is dade of it in dl€ iflti,l phzse of therapr The
UsECsGUDEro rHEMMFT CoDEoFEIHrs
therapist decided that termiMtion dd rcfeiral Ms the best option and in accold vith the method, reve2ledthe ftearment to the famillL On let'ning of the subter fuge, the fxmny reie.ted the the.apistt plea for undeGranding and dgrnr stated they fdt like guinea p1gs.They left the final scssior with the erpressed htent of
COMMENTS (c): Before impleoemiDg an experimental ftarnent, a derapist nust obtain the clientl hforhed consen! This includcs baking rhe clidt awde of the eiperlment3lnatue ofrhe trc.t'nenr.rd the potential.isksassociated s'irh ruas wcl as informing dre client there may bc unklowr ;sks associatedMdl the
\r|lreo traditionll trcxtments de us€d, the code does nor rcquirc thc disclosue of risks.Any such disclosing is at the therapist'sdiscretio.. Thenpisrs may choosero ensee thzt clientsposses th dnt Mn successhnrh@py may jnvolve dpredictable emotional discomforr md/or relation,l chmges. Cli ents cxn be informed that although a fteatment has been shown to be successfirl with odrers, tlere is .o wry to determine lccuntely beforehmd rhat &e dealmeot win be successfulfor drcm. VIGNETTE (d): A client inti,ted sessionswith an MFT to addJesssymptons of depressionassoci,ted wnh a troubled 30-yed hdiage The cLientand therapist vorked together fo. eighr sessionsand cstablisheda close md effecdve working ielationshjp. The therapist felt it was rime for the client s spouseto ioin fien in rbe next session.When th€ client stated they should wit, the therapist r€luctmtly agleedbut stipul2ted that the spousewould need to ioin rhem by rhe reoth se$ion or the therapist would refer the c,se to moiher practitjoner At fie tend, session, the spouseappearcdard complained bitterly that rhe clienr hld rhreatenedsudde udes dE spousesubditted to con'oirt rreatnenr. Fur&ermore, whne the spouse ,greed to attcnd sessionsout of fer for dE ctient'swel being, the spousew2svery angry at both the cli€nt ud the therapist, and srated rhe interr to complain to
CoMMENTS (d): This is d exanple of how effofts ro bring reluctdt pdtners into the.apy can extort cooperxtion arher than win ir. Chnd.en especiatll.d be victihs of involutary cooscnt. Therapists hust assesscre6nly rhe motives rhat bring then cLentsto therapy md ensurerhat consentis &eelj, glven our of 2 clerly perceivedbenefit froh tbe treatmenL
l.l - 1.6 CH!,*RI - SuBpRNcrPE
1.3 fronioge ond tomry rh€ropists ore awoie of lheit influ€nliol posifons with req€ct to cf'enfs, ond ftey ovold €$loiling lhe trust ond dependency of 3uch persons. fhempi-iE lhdeforc. moke ev€ry eftort to ovoid .onddions ond wilh dre'tls lhot colld inPoit Prolessionol iudgmenf ot m'iliple.dolio.rsltFr lh€ dd( of €xploilolion. Sudr tdoriodtips indud€, bur or€ not i|('€ose fin*t€d to. brrdn€ss or dose p€rsord r€britoships with o del* or lfie dienrs imrn€dote tondh. When lhe dC( of irFoinn€ir or er9biiorion €xlsts due fo condtkrns or muliple roles. lh€rofists toke qPFoPdste precoulions. VIGNETTE: An MFT was c,led by a clie.t vhose Partnerhadbccomcviolent during a quarrel. An emergencr sessionwith the couPl€ was scheduledfor c4.ly the ncxt moroin8 At the tust meeting, the thenpist nored but did not commcnl a! rhe ume rhat dr p,itner was thc postal \lorker vho delivocd the theraPistt dally
Folowing fie nnal sessionin which eachPartner wzs inrervicwcd alone aod conjoindy aod consftucteda sefettplan fo. lhe clenq the thcrapistrcceivedno man for seveGl srdght dr)s. Repeatedcals to the post offi.e yielded no cxplaoation. the mdy vaysin which tbe clie.twas In the secondseslon, thc parmercataloged nept. Thc thought crcssedthe therapist\ mi.d that !h€ Pdtne. h2d considerablc hnuence o\cr the ther2prst'sda y life, evcn financial wel being Man rcsunred aftcr that session.The therapistspcrt time in the fiird sessjonalonewirh the pdtner to dezl with tie maii delivery issue-The Pdtner denied knowi.g a.ydrlng, bur ihe foloving day no mait was delivered. Inte. the thenpnt cancelted,I sesnons ihe next day a.d wit€d on the cturicrt route inlending to rbreaten a formal a ycling match compl4iot. Again de p,Itner denied withlolding man de[vdy, ^nd e.suedrNeidtr the dient nor the partnershoweduP for the nex! scheddedses sio', dd dr therap;t hcard nothi.g mEl a cal from thc SrateRegllatory ]loard revcaledthat thc dieots had fited a codplaht. Mcanwhne, the postmaster caled thc thcrapist to apologize for disrupted ddivcy due to a d,ltuncboning man so!t'
COMMENTS: No ovc.t relationship ms iohed betwceDthe ther2Plsi md dE mail carrier (the partner); nonetheless,the thdapist dependedo! the caftic ior an importnt sedce. This dependcrcy consdruted 2 potential thlcat to the t.eatmdt that shodd have been recognizcd.Moy of rhe therapist: clients vere brm€d by the thcrapistt failure to rcfer the parmer to anothe. theraPGtas soon.s the rchtionship\ias knovn.
IJsER's GUDEro rHEMMFT CoDEoFErHrcs
1.4 ser(l,ol Inlimocy *r'lh denl5 i3 p.!fibitsd. VIGNBTTE: An MFI established dep dd ding relarionships wirh dients S€ssioc oftefl induded touch a pat on the dm or bact! or a hug who initiated by the cli€nt. The thenpist was careful to 6k permission whs tochi.g a cljst the
Jamieand Morgan enteredtherapycomplaining of mg€r md frusttation stemoing ftom differences in drn preftrred modes of dpGsing iffation seiualy. They reLr€d thatjamie desired to engagein more public displaysof scNality rh.t in cluded rubbing agaioststrdgets while Mo.gm djsEacted then. Ioitialt Molga coopehted rith tlaeseepisodesbecaue vheo they wee alone,Jdie szs a nore patient dd cding lovd. But over rhe past ya, Morgm had re66ed to p,nicipate and aI s€xualrdadons ber.reen dE coupie had come to a halt. Both felt trepped and abusedby dre o&( In dr initial sessionin vhjch tk patieis openly erpressed fed for $eir l€lationship, the tnaapnt fdt rdded dd srongty comected vitn the couple. Ijte in tle sesion, Morgm broke dowq sobbing for d dtdded time The &dapist wited for Jamie to offer nonverbal support md wh€n it be@e cld &.t would not occur, th€ thenpist moved close to Morgm md offqed a hdd to hold. Mogan latch€d on and hdd tighdy, pdling the $er.pist close Jadie qploded with a b! ra$ of questions: How could Morgo be so opeoly expr€ssirevit]' r strmgei \I4Et did th€ theEpist haE tlatJdie lacked?How could tlE th@pist fal for Morgmt mmiputations? with the last statem€nt,Jmie abrupdy left th€ $ssion, slalrDing the dooi on the vay out md ptomisi.a to 6re a conplainl COMMENTS: Sdu2l intimrcy enconpass€sa brozd r,.ge of behauor dterlding vel beyond engrE;ngin intqcose or touching a diot's genitals P&k on tle cheeL,holding 2 cli€lds hd4 or light hugdng may have sexu,l ude.ton€s vith slrong assodatioG for cliefts. Therapist intent is importnt in determiningsfieihd sexualhtimacy occus, hovsd, clidt pdeption is nnpoitant as wlL ln this czse,the $dapist dgaged in , comon pactice (offering suppon by hold' ing the dioCs he4 in d mcolMon sitution. The preseniing problem should have ,lefted th€ thqapist drat touch rculd pove to be a tip wire ddy bit 6 evocativeas more ovet fo@s of squd in&Dacy. Touch is no small matter between th€€pist md cli€nr. Ceetu], do@€ntable ds€$m€nt must plecede acrion. Sosiriviry is r€quired alwys dd esp€cialy vh€n
1 - SuBPsNorus1.1_ 1.6 CHAflTR
p €nting problms involve *xu2l abuse. Blank€t 2ssmPtions rlst clieots will perceivetouch of my kiod 6 noNexurl de f,ot wdted Some iheBpist5 make it a Pectice not to touch cLrentsbeyond 2 hmdshake on It t]rey ae mcaing, cold, o! ffsponsi!€. beeting iaiti,lly. That do€s not oo Lhe Lo dd ftrv misper
f5 s€x.rol itnnacy lilh lqr|€r d€nfs k tkdy fo ba hnnftrl ond b th€r€for€ p|lhitihd tor lwo years tolo{irg *|€ t€nrinolbn ot th.EPy or h5i fha liust ond de9€.detrcy !.Df63Cood con|lct h otr db.f fo avokl €4hft|9 '|r| of d€.rli. trotdogF qd to|r|.t lhglpiBts dtosld not €rUogE s€nlol tsrninolior| o. hsl htinocy wl|h fonrEr cM3 oi€r lfie hvo lta3 followitrg g€og€ form.r ififimo
Usrn!Gurorro rseAAMFTCoDE oFErgtcs
CHAFTR I - SusPeNorus 1.1- 1.6
caued an "existenti,l crisis." The exdienr re6&d and said tlat life wdnt bad enough to need any help f.om the therapisl
pisr to v€rify deir c12in but decided not to dd let &e mattq drop.
R€aIziDgthe seriousressof rhe ex-client'scondition, tne tldapist solght consultetion from a colieague.They decided that rhe coneagu€would contact the €x di€nt, despite th€ confidotiality breech, aod offa fiee co'sulration or hddle my shorr tqm .ommitment procedures. Meowhilq the thdapist would rcpoft dr affair to the Ethics Comminee md stand up to any consequences. COMMENTS: The tndpist failed to dercise good iudgment in becomiqg sexu aly involved with a former cliert despirc rhe passingof the req*ed ninioum of two yea6 since the last profession,l conracr. The didq ad possibly the diencs spouseas wel, wele hdned by the affan Vith a[ past clients &ere is rhe possibility that they vil seekto r€est.btish strvices with rh& prior the4pist. Vhen that optioo is dosed becaus€a flon therapeutic relationship hd developed, th€ clenr suff€rs" In this isrance had tlE theEpisr been vis€ oough to aloid becoming sdu2ly involved, r}te outcon€ may have bed vdy diff€(ert An anhction €xistcd dding rhenpy its€lf but v6 hddted appropriately. The context for the aftu dl@py affeir howvet w6 cstabtished within the tnerapy. As a esult, oo ini resolution of the therapy rclationship occutr€d €wn though 2q extendcd time had passed.It ws the theepGt's responsibil itJ' to protect the clist aqd dre cli€nls fmily ad ro possibly never becone romad trcaly involved or ro eDgageir my othq q?e of relationship vith rhis didr 1.6 firorirg. ond fomiry fi€ropbls compt rdrh opplicobh hvs tegErdng the topoding ol oleg€d unelhicql cordJcf. VIGNETTB: In o inirial session,a MFI lqmed dEr a nw diert couple.vho hd beensr€n by r prMo6 $empisl we,erdvisedto ad $o rel&ionship.The previous theEFist had said the paroeF wqe conflicr h,bitured dd tlDt since their viol€nt episodesvde escalating,s€pdado w6 recom€nded atong wirh divorce sirce th€ pattein was lo.g srdding Oa h@ring r}lis aduce the couplc endeddre sessioDswiil the prdious thqapist. Th& religiou co.vicrions did not permit divoi.e, dd sepetio! would hav€ been highly dbdassi'g in dr& rdigious commmiry Aier a month aMy fiom fieFpy, $e couple decided ro try workhg with a new therapisL As do mdy theapisrs who hee this story from clients, the qw therapisr vondered whcther rleL ,l]€garion vas true. The ntu tlerapist consideredasling the coupl€t permission to contact the previous rhes,
ln the scond sessioqthe couple pressedtle nd therapist to say tlat tleir ftsr dr@pist es qrcng, dd dnt dEy should stay togedri The th€rapist refued. Uule progless ws made,ud they failed to show fo. a rhird sessior Sertral weeks lat€r dr new *€hpist was c,led by a reponer who s6 mrking on e story de' rcribing fie couplet ioint suicida A note tefr behind had r€lated hov the couple had @ntact€d their fist fterapisr who had reassded the need to diwrce. Th€i! note also sbted rlEt the nq thenpisr had not supported their desne to redain togetld. The repoitd 6ked why the ns dEEpist had not repolr€d dre previous thenpnt as requied by state lav The nd thqapist was prosecuredfor d erhics code violation ude statelav On conviction, the Regulatory Bodd.€port€d the c6e to AAMFT fot action by the
COMMENTS: Bo$ theapists lived in a state wh(€ r€porting susp€ctedethics codeuoletions by otltt drhpists is m@dated (tlis is trE of ,ll statesvhere the Aeencm Assciation of Md;ag€ 6d Fdily Th€Mpy R€gulatoryBoardt Model Code of Ethics is the statutory cod€). W}€re r€porting is mmdated, dErapists
In dis instance,a se€minglymino. brerch of the statecode and the A-AMFT Code had Lelh.l consequoces. The tn@pist should haE mede the coupie awde thar th€y could issuea cooplaint md thar if they chos€ not to, th€ therapist would do
I 7' l.l3 GaPTER 2 - SuBPRrNorus
Pnxons l: Sugpsxoptts1.7rxnouexl.l3 Rrspon$ trYTo GttNrs lrotF
)
tet€l3on Annour, 'lLD.
L
l.7llqftge dd ffiy fi|e tpbts do ttoi ute their pro'€5sbnolr€|l'|iooshiF sith d€r|l3 io irdte. lh€t own 'ril€!€.ts. VIGNETTE: Sadr a respect€dmd highly erPerimced MFT in Priute practice, received refenek from a vaiety of soaces Smdy's sPouseAvdy ws receDtly liceNed 6 a lfui;ge dd f@ily dErapist fd trying to bund a pnctic€. Aveiy Nd Sody's of6ce to seedi€ns. Smdy receied a call from a ieftrral souc€ vho 96 s€eioga couple dd !6ted to lefer the husbmd to Avqr The refernl souice bdimd that Avery h* tlE maturity and confrd€nce to be Pdtidldly h€IFtul to th; man who had recmdy b@n laid off mrh Sody conceed md encoumg€dthe rfdnL Avery begd seeingdE dienL After sir sessions,A!.ery got into a shouting @tch wi$ dE hsbmd about tne husbmd's te 6$al to actiftly seach for employmdt. Shordy &ereafte! Sddy rc€ived a cal ftom tle referal souce who head, ftom the couple, about dE disAttous sessior COMMENTS: This subprinciple !€quir€s MFTS to be avKe of deir Pdsonal notiwtioN in making decisios that impact dients It is built od the Prdise that petsonel needs qo doud the clinician's ability to b€ obi€ctive od potentialy im' pai( &e primcy of attotioo to tle clienfs needs.Io this ddPlq Sddy consulted vitn t}Ie refcFl rcKe about A€yt prof€$ional qualiEotions od agreeddnt a rcfcrrl to Aver/ was ,ppropriate. Smdy could not be crtain that the asse$m€nt of Avqy vas obiecti€ b@u€ Avdy vas Sddy's spous€.Moteover, sinceAvery nryly licced dd trying to build a praciice, it is Probzbletlat Sddyt oPinion '6 wa! influencd by a desire to help Avery get start€d.By using Saddy'soffice, Avery minim;ed qpeoses. ConsequeDdy,Smdyt suPPort of t}le rcfe.rat may,lso have bem motiEted by Sddy's @trcdD for their ioint finmciai situatiooWhile rcr the prihary drmpist fot ih€ cli€nt, Sddy oay have been ;Ned as a in this c6e. The efdrel souce cootacted Sddy kind of superior o. "supdisof b@e of Sady's cput tion ard €xpe.tbe Sddy advisedthe refefial souce to pced in contacting Avdy. Wheo dings blN up, dF refdral souce .g.io con-
UsER's GU|DE TorHEMMFT CoDEoFErH6
12
ractedSand} BecauseAvery worked out of Saodyt office, the perceptioo could be dEt Sddy was responsible for the gu,lity of Avery s worK. Fanily memberswho work togeth€r tu€ rdnefrble to impoprieties Consequentl, stnct openting bomddies must be enforced to monitor dd haistain rte divisioo betveen personal md profession2r rehrionships. If Avery dd Sddy hed dJaw! up a formal contract that delineatedrhe bomddes in the; @rkhg elanodship, Smdy might have be€r benei prepared to respood to rhe rquest for guidmce frcm the referr,l source.The !€f€tal souce could have been rotd that Smdy wa not aqilable to coment oa Avqy be.2u€ of rte spousalret tionship. Smdymay not have been objective in this siru.tion ed therefor, my eDcowaAemeotm.y havebeen construed by others d a poteetial conflict of inrqest. Smdy might atso havesuggestedrhat rlle refernl souce contaa Avay direcdy vidt questions Sddy could have.lso recomended two or rhree orhq thehpisrs to the ftfd.,l souce '1.8moriog. ond tomly lh€rop''sts E5p€ct the .ighb of cfiodi ro mal(e d€dlot|s ond h€lp th€m to und€rsiord $l€ cot$quer|c.B ot the3e ffi.E theropbts d€ort oddse the ddtB ftcr $oy have tt|e ?E porublfy ro rd€ decidoB rqofding r€lolion$ips erdr os colEhlHio.L n|ontEc, d'vorEe, soporatlon, r€co.dllodoo, ars'ody, dd vilitidiorl. YIGNETTE: Murey dd Ca@I sought couples dErapy from d MFL The couple fdt that one of Cdroll parentshad a deserctive innuenc€ on Cdon md Carrcl's relationship virh Muny. Atnough chndhood nemories vde r€w,Cdrcfl felt 2s though serual abus€had occDned in.hndh@d at the hdds of rhis p.ml Cdrol vrted the cliniciu, who had rhe rraining ad expqioce to treat sexu,l abuseissus including rccovqed meDories, to help in th€ Eco€y of m€mories. The clinicim felt rhar Cdrol may haft b@n absed but did bdi*e thar ir u6 expeditious to "hudt" for ftemories 'Aftet a[ tne abuse,if'orit happded, wuld hzveoccued long ago md srayingstuck in tne p6t wil not h€lp you to li€ in the presol" The clinioan, therefore, pdsuded C&roU ro focu on lurcnt poblehs in fie .oJplei rclaEonship.tud also recomdded that Carou have less (onr/c, with th€ parent in question beouse the pcnt seoed in6iE dd cootrollinq of rhe.ouplei lite C! roJ rool, r}leMFT\ Komendatjon md rotd &e p{eo' rn,' th€therapBihadadq.eddDttheynorro h,!econt .L.Thereforc,- saiJCarcU the parent, "we wost be gening togerld in th€ turue,' Gnofl's p.mt gA turi'o ous ud Oedr complixl, Th€ prenr al%rd thar Ge tllffipisr h; erertedundue influence on a rd!€rable dient and that this influeoce ws dstrucrive ro th€ fd jly. The dB2pist was shocked by dE ,Iegation shce ody .recomendina' rlnt CdrcI have lecs Edlq drr no contacrwiin rhe prenr.
CraP'R 2 - grBmNqflrs l.7 - l.l3
l3
CoMMENTS: This subprinciple requk€s MFTS to both respect clidt ser-detdbiMtion od to p!@ide clierts vith the infoimation to hdp them mak€ infomed choice It 6nth6 stipul*es dnt MFT'S i.fom cli6ts thar th€ cliefts ae respoGible for dy da;ioN they make. In this example,the Aenpist milateraly deided that th€ di€ot shodd .ot puJsuemeBories of possiblechildh@d s6uzl abue. In so doin& the tlqapist forcdosed dy €xplontion od dismissed the dientt concm l6tad of .dd6sing dE cliott agetrdathe theEpist adviseddle dior ro h.re lss conr.ct with dle cliqrCs pdenl At rhe tnne dE rhqtPist oad€ t}Ie il@pist elso did not r@ind the client of the clienls dle recomodatioa respoDsibilityfor wb.revd dedsio. ws mde Cons€quendy,the client made t}te rldapist tes?onsible fo! th€ deision. The cllent's p{ent prohably fdt conftoled by tbe th€episrb powr @er dF dienCsdecisions md dftatened by the potdtial lossof the penCs adult child. The p*ot therefce massed pN€r ovd the $enpist by (D?kinga complaint to the licdsing b@d M€otal he.Id! professiorals hde hody deb.t€d dE issueof memory !€tdei"l. lnstead of making a Eilaterel de.ision about not pEsuiog m€mories of possible childhood sdul abs., the thd?ist could hde helped the clot h,ke I more info.med d.&iotr by F@iding the clientvith information about tmmatic moories a v€I 6 issu€sabout tle reli^bjlity of chndhood mmory Ptoviding hforution vould ha€ met the requireMt id dE pdnciple foi h€lpiog clieots undersfud dE @Nequoce of th€n decisions. Moreor€r, since there wee qisting isu6 io the r€lationship betw€en tl€ dieot,nd the didis prcnq th€ therapist could lal€ suggesteddat CarcI sek th@py for Carol alone ot for Caroll aad Cmll's pd€nr Erhe. rho advisi'g dE dient to avoid issuesby not seeing dE
ody so r.f9 m.rrtdgp cd ffiy th€rlff* co. ln e fil€ Feulic rdolio.r*iF lo.|9 03 ir b r@ndly d6a lhot clqts q€ bs|efiltE film lhe r€lofbn*ip, YIGNETTE: Paige dd Paige'schil4 Tyld, wc in rlenpy with MFT Ixsli€. Paigevs atso a m6t l health Fofessiooal who did one-sessionmdt l heardr AsssDents, fu ih€ court, of peents in cbild clstody disputes Tosdd th. od of ds€rsing a clien! Paigeldned &at a dient wd also id thdapy vith lalie. Paige cobpleted tne ,ss6smot dd Ltq 6ked several @I€agu€s to rwiw the wrk done to ensrc 6at Paig€t co(duions wee unbiasedand substaatiatedby f^cts. Paige repoft€d dE situation to Lslie. Iislie ws upset dd insisrcd that Paige should bavestopped the assessmdt dd caled in somone dse to do iL Iasli€ also mantaned dEt PaigcDeededto @dtact &e lic€osing bodd ed repott that Palge
UsrR'sGUDEro rHEMMFT CoDEoFErHtcJ
l4
had eagagedin a dual rclationship vith dle clien! P4ige felt blamed by Islie fo. &e prcblem2tic situ2tion. Paigewonde.ed how kslie .ould continue to do rh@py with Paigedd Tyld siaceIf,slie \6 so mgry. 'M,ybe kslie won t €re wirl my assesment of the clieqL Maybe dle cliot *in be ,.giy with ne for my assessner and talk to kdie about jL How cm Ialie kep ,I dEt st aiChrad continue to see both d,e client rd ne md Tylq?" \Xften Ptge raisedthese concer.s *irh lalie, Iislie indicated tha. th€ only probleh \6 Paig€who n eded to "own" what bad gone woog: Lesli€ slggested they meet without Paigeh chnd un6l dris could be sorted thtough. Paigecomplied becausethe thopy $A import nt to Paig€.HN we! Paigeteft €ach sessionfeding that Paigemd Ialie vqe in , tug of seJ ov< vho had dore wh,t to vhom- Ultimatelt Paigedecided to leer dErapy becaue the€ ws no vay to iesolve the issuesberween tkdCOMMENTS: This subprinciple requnesMFTS ro discontinue rhosetheepeu, tic relationships th2t do not benefit clients. It raisesquestionsabout 1) vhat is od is not beneficial, and 2) who sil determhe that the lelationship is not bene6ci,l In this qaFplq a dormant dual relationship Ms sudd€nly actiqted. lxslie dd P+€ becme profe$ional colleagues4 vel a th@pist aod client. The therapist did not recognize that continuing the retationship wuld be hdttul to the clienL Indeed,kslie probably inrelpreted Pdge'spain 6 guilt for ot defeosivm€ssagainst recogoizing Paigch &ror in clhical iudemeot. Moreover, Lslie dismissed Paiget concerns about Iislie seeingbofi Pajge md the clienr Paigehad *sessed. ?dge had to nake the decision, 6defore, to teroinate th€ therapeuricrclationship. ln dced, Paige was .ledly not benendrg from conrinuing the r}lenpr As l^eslie's cliert, Paige felt &2t ksli€ b€can€ a supcfrisor who had lle ieqdsite kn@ledge md right to e\,lete Paiget clioical judgm€nt. When Paigenised apprcdate questioDs about the tdangl€ between kslie, Paige,@d the ssessed client, Lslie d; rnissedPaig€'sconcerns add left P2ige,rone to rcr.y aboufth€ pot€nrial for ongc iog probleos. Finaly, when Ialie told Paige to h,ke a rcport to rhe liceNing boald, Paige felt blamed for cirMstdc€s beyond Pai$'s contrcl. lnde€4 Paige: efforB to eDsurea unbi6cd repon were not recognizedby r.s[€. Som€ dual rel2tionships re not piedjcrabl€ or avoidable R4olution of problehs usually results io a lo$ for one or more pe6ons. In ilis dmplq Paige lost the d€rapist. It could be dgued dut Ptge broke confrd€nti,rity by shaiirg dle siru tton vith I-eslie.It could also be dgu€d that not shding the sitution rculd have cr€ateda secret about the fact dat cliedt @d th€rapist wqe ther also cotleegues who shareda.lient. This seff€t codd also hav€ infecr€d the thenDeutic relanonship.
LH A P IIR Z - 5TJB 9E N OA 6 I/-I.IJ
l5
l.lo t{drioge qtd foflrly rherapbk oss&f pdsorrs in obkining olh€r ft€rqdrt s€flic.s it fh6 |l|erq,bt ir unobb or unwillhgr for oppmpdde .eosonr, b p.o$de Fofs3ioiol l|€b. YIGNETTE: MFT G,len saw Shamon aodJess€for couples &eBpy. Shdnon had bcen grmt€d a l€aw of absmce from work hecNse of depre$ion. Although calen atteopt€d to schedulesessioc for the couple,Jessettsv€l schedd€ madeit difGcdt forJesse ro attdd s€ssions.Gale' usualy €nded up seeingShmon ,Ione. After sevdal mon&s of working together, Shmon decided to ioin Jesseshs traveli.& 6 a wy to mdage Shmnon's deprersion. "l iust feel vo6e when l'b l€ft aI arone." As a lesdq G,led could .Iot estabiish dy regddicy or momentw ia either th€ couplesor indtuidld tnenp)r Shmon continued to be depresscdard Epoited no imp.ovment. Shmon pr@ided Galen with a iequ€st md releaseof info@tion to enabl€ Galen to s€nd a pogr€ss r€po.t to Shmon's ehployer. Shdotr had asked fo. m €xteoded leaveof absence Galen rcpolt€d that ShoooD or y atteoded s€ssioosinfrequendy od thar ao real prcgtess had be€n made. Cons€quendy,Shmoo !€cerred nouficadon that l@ve and beneEtswo!.ld oot b€ qtended. Sbrryon vas firious ar vhat Galen had reporte4 dd insisted dut the iel problem Ms tlte tnqap;t's incompetence. Sh,mon also caled Gald dd d€mded t',ice-wekly sessionsin ords to pror to Shamon's mployd thrt Sbmon q^ sqious about thenpy. Equ.ly upset, Gat6 woded aboBt a &m€ed reputation i! th€ professioD,l comrnmity aswel a ShmoDt possible mis u€ of thenpy to get ben€fits G,Ien varoed the psychiauist vho had prescribed zbout Shtuonl ll@ipniation. G"len decided not to Shdont dtidepBsdts seeShlmon. Whd Sh,mon askedfor refeiols, Gald reftsed to give ay narn€s. "Since tle nm€s wuld come froo me, thesc ihempisrs vouldnl heve i chdce. Youd iuit seedld $ iocompeteot toq' COMMENTS: This subpriociple recognizes that th€re de ci(umstances when the thetapist bay need to discontinue seFic€s to a cliem(t. Howws, the plidciple stipulatesdnt 6e th@$t oust help clidts obtain otler th@peutic seflices. ln dds e'mple, Galq w6 uwiung to cortioue giviog thcrapy ro Shamon because Galen supected that Shaftlon P6 oissirg &@py to obtaio *tended bdenti AldDDgh $e da;lion to discortinre thetapy may hare ben appropriare, caldt efiaal to gjc efdals left Shamon stdded. Gal€n3 cal to th€ psychiairist may bzve also ostr.cizd Sh,mon dd id(:Esed Shmon! isolatio!. cal€ot b€havio! with Sbmotrt employe. was quGiiomble as v€[. Although Shmon signed a rcldc of informatio., Shmon pbbably did dot €+ect G,len to r€po.r dreinfre quencyof thenpy sessio.sdd Shmon's lack of progresr, Rath€r than reportiog' ShmoD to dr€ eoployd, Gal€n should h,e talked dnecdy to Shmoo about
GuD€ro mEMMFT coDtoFE cs UsER's
'16
theseconcerns. G,16 also should hav€ t Led sith Sh,mod Priot to sddi'8 the report. It is posrible that Shmon might haw rfloLed ihe cons€nt to releasei'{ormation aftc being informed of Galen's oPinions Tafting ose&e nigbt also or have qiven Galen and Sharyton the oPportdiry to ei&er discoftoue heraPy a good efocis it in a nore productive direction. Finalv, Gelent dietv to prctqt lheBPv Drofessionl repurrdonb.y ha( beenr sdongermodsror to dis(onEfue ot the procFls Plrfd'blv' G'Joi nodqtions po.,Ut" il- Sh*on: jn consultarioDwith 2 suP€nisoi before Gard mad€ would have been emincd -i"use the decision to retuse servicesro Shdon
m ifonioE€otd lomllylt|erQkls do notdon&n or negle'f"ryti" ! frwfnrer*-wi*nuf motingrecsonotleontngEtrstls for lh€ corninuolioiot sudllr€otm6nt VIGNETTET Brook sought help from MFT Aden fot Ril€v, B@kt 6 ved old child. Brook ws divorc€d dd conc€rned ttut Rnev@s not maftinga good adjust ment. 'a4y formd sPouseonly seesRilev ocdione]lv' Mv chnd feds like a or Dhan."Brook 6{ther leported t}Et Rnev vs {€ry,1'shed out atBrook' dd pro_ ioked fights witr' the cl'ildren at sch@I. Brook felt fo'tutbte that Aden ws viniog to se Riley Aden was m eceptional thenpist md accePt€doolv ' hand6n of !4 dd climts eJ yeat Btok va viling to Pav dv f@, chaogeRiley's sch€dure, dp'caniss impoltdt meetiogsin ordt to seeAden Aden lired uP to Bt@k's Ad€nt guidoce dd Br@k was given nd skins fot tio* nn"v fl"*"."d hon . Biool terdisted tll@pv feeli'g gflrcI and d wrking with Rney ar-der oorered. Brook mdenmd 60o Aden tlut B@L ad Rilevcould rctun et ot larer,BlooL! tordd spousenoved in with I i-. i". oorc thenov. Sir -onils wi$ qtreme a.Aer ed sleepdistdhuces Brool p,rm* m"y a"in ""* -*ted calj Adea for help. w}rcn the cal @s not ietdned, Brook left messages'bour vhat was hapF€ningto Riley.After two weLs of no resPonle, Brook smt a lettd i! d€sctibing *; effo; to reach Ad€n. Brool 6ke'l if Ado had beo offedded l€ner sdt a final B@k len6, no rcsPonse to the r"-" ** Wft* ,r'.- * €xpresing dge nd diePPointnent, md describing th€ difficdtv in dplainiog the similaiitv b€tween Aden's actioc md &ose o{ a.i-l'. SJt."i". t" mor, rc -a BrooL's formd sPouse.Brook esked fot referrals for Rilev but receied no COMMENTS: This subPrinciplchiShlighs LhetheBPist: comirrnent ro $' be' cli€nt. lt ct€atesa sefety ret so that diots cd risk showing who thev d€ or bei.g desdt€4 forgotten, o! ignored lt 6rhe! dids comingdepddentsitlout
CHAPTER 2 - SU3PRrNoPrrs 1.7 - 1.13
t7
the thmpist to rEk€ drug@€ots for dE conti.ution of seflices if md vhen th€ th€Fpist camot attod to the dient's d€eds.ln this example,Br@k fomed a tight bond with Ad6 basedon rcputation, help wi$ Rney,dd dE expiicit uderst nding that Ad€n would be availablein the tuture Whetr anempting to aercise th€ oprion of .etunirg for more helB Ado vas not auneHe Moreovd, Aden's lack of respons€left Br@k questioning if Brook was to bl2me for AdenS sil€nce. Unfon@tely, Aden's sil€nc€ !€Flic,ted rhe unpredictability md idco.sisrency of B@k's fom6 spous€in rBponding to Riley's ne€ds Did Ade. have a responsi bility to rapord to Brcok? From Add3 peFpectire, Brook ud Riley wre fomer dio6. Ir corddbc argued,Lhdior. dur Aden\ l,ck of r5pon5r djd nor con\ri tut€ abodom€nt or negleci Moreo\€r, sioce Biook md Riley wue not curent .lients, Ado !A dder no obligation to mke rnngements for the conrinurtion of aheir therapy. lt could be turthe! argued, how€r, t}l.r rhe implicit conEact betw€eoAden dd Brook dd Riley *as for additional senices on m u-neded ba( Sioce Aden had agr€ed to that drdgemenq Aden probably had some re sponsibilty to r€spond to Br@k md to provide refeft,ls if unable to seeBrook md Rjley for additioral drmpy.
1r2 flo.riogE qd ffit fh€n?l3ls obtin wfir€n inlonned con3eoi from d€rns b€iore $deon+hg, oudolioping, o. p€.|nltltrg lHd-part obd€wotbr. VIGNETfE: M,ny y€aJsago, MFMimey hd a tr2ining prograr! for mdtal he,ltn pior€ssio.als doing fmioist fmily theapy. Whitn€y would pqiodicaly bdng in natioratty recognized fdinist f,mit rleBpists ro do tnining dd interviw live fdili€s. The families (:de fio6 th€ cddoads of rlE professiolals in the trainirg prcglu. The fmilies wqe given . coDsor form $at *plaio€d $at dre Lives€ssiodwuld be taped dd rcdd b6 ued only for educariooa.lpurposes. D,Ls ws a tnio€€ iq \vhimey's progr@. On oa€ Gc6ioD, Delas invited a clidt couple to b€ intwiwed by the nation l Frqqtd. The intdviev ws poducrive @d DaJas ceied Irdy helpfii suggestioos.Datlas tdminared vith the couple afte! s€eiog dro for sdd,l nore qonths Fifted rers lare., Dallas found out that V4ritney Ms tachi.g at the miv€city dd using the rap€of the couple in the fmily theBpy cose Dalas wa ups€t since one member of rh€ couple worled ro. th€ uoiveGity dd might be recogniz€dby someonein wlit cl6s6. Drla '€yt met vith V4rit ey to diicuss this concm. WhirDey]m suprised to fhd drat one member of the couple wiked at the miwsiry, but said, '3orh members of the couple sign€d dE consent fom dd I @ ooly usiog the videorape for edu@tional puposes Beides, tlse wes no date for when the consedt *ould expie"
UsER's GUDEro rHEMMFT CoDEoFErHrs
t8
COMMENTS: This subprinciPle,Iows MFTS to show to third pdties what hd occured (ot is occuffing) in therapy provided the dieot gi€s witten infomed corsenL Informed consdt goesbeyond simpl€ Frmissioo lt lBts on the Preds' th.t tlle professiotralhas a duty to discloseto ih€ client hfor@tion that allovs thc client to male a reaonable decision ieg{ditg his or h€r PattidPation in tra$nenr or otha endeavot.Dewiry on SubPrinciPle1 2 conc€.oing mformed consent for tt erapy,we cd infer thzt complete ioformed coffent for thnd-Prtv viNing oI clinic2l deterial would r€qune that dients 1) have &e opaciry to cons€nq 2) har that *ould influence conbeen zdequarelyidormed of ngoifidt infortutio' seot,including potentjzl riskq 3) have fredy ad without udue influeoc€ dPressed consdq md 4) haveprdided consentthat is aPProPr;t€ly docuent€d- The colPlc was nor apprisedof tnc risks of ngning a Elasc with no exPin' in this *npl€ don dare o! plovlsion fo. rene*4t of de consent They wqe thererore not grvd adequat€irformtion. Moreova, they vde not advised that cli€nts could took' thejJ cons€nt at any tjme dd for oy reason with resPect to 6rte us€ of ihc not avd tlat \i(hitiey wa showi'g the 610' mlteiial. Wtile t}le couPle '6 Dallls's concern for th€ aoonymiry of Dehst client! w.s suffideot reason for \X4imey to discontinue using it. Fi.ally,'i{ftitney !2s showing the 6ln in a contexr not dticipated by the clients when dreysigned dle Mivd y€a.sbefore' Thev m€hr havewithheld coosent if thet krN that one day ihe 6lrn wuld be shom in tnen placeof oployment. A legalistic aPProachto this scMio might find it adequat' t}llt t]re cndts had agreedro "educational use" for m unimited time Pdiod But Subpiinciple 1.121 highd ethic.l stmdard idPlies dEt this significdt shifr i. dr use of the frlrn undercuts th€ couple's original consetrtand th4€fore it (,mot b' assumedthat the couPlet interestsw€le adeq@telyProtected i! the @r€ot situ4 tion. To rmedy this, whimey would needto seeka renewedconsett contnct frcn rhe couple ecpting us of the 6itn in the nev lootioi! for a sP€cified timq tukhg n cre' $ar eifi€r hdvduat codd urhdraw pamission dt dv timr' r.B rnonioge cnd fomty lh.ropfuis, uPoo ogreeing lo Pr!*le s€tties lo o oq3on or €nlit dt lhe r€qr€st of o ftnd Porly, dqify, to lfic etd€rt faosab imd at lh. o,ft€t of lhe t;t"ke rh€ nat'rn of rh€ r€loliordft rdfti €odl pdty ond lfi€ linils ot co||fidd{iony' The Piesb}.ter/ 6ked a tlt@Pist to see tw dinisters s:tb wi( VIGNETTE: having communicltion problems. ''We havea seoiot minister vho ha madesoo( pou decisions.Indeed, we h2ve lost fou steff beca6e fiev cd't get along Mti the ministei We have a new 6sist4t minister vho is M€xicd Americo dd st do not wdr to lose mothei pe6on. Somemembersof the co'grcgatioo' howev€'
1.7 - 1.13 CHAPTER 2 - suBPRrNcrPtEs
't9
feel rhat ihe asslsrantminister is cold dd l]mvan2He vould you s€edrem to helP th€n @rk out t}leir commmic'tion difficultiesl' Dell agreedto se€the two minjsteK At the fi6! session,DeI totd the ministers thar eEr)thing they talked about rould be kept confidential. The scDio! minister lnsisted that dte assistart minister kep the content of &e sessionsconfid€ntial too. Fou sessionswtue hdd. DeI re.Iized that the problem w6 much i"rger d6 commmication issues@d included ch{ges by rhe dsistant qinist€r that the senio! minist€r comoonly lied or d;toited infolmation md &2t dr senior minister had also had ioappropnate rel" tionships with pdshionds. \vlEn $e Presb)tery caled for m uPdate,Deli felt bound. Dell had not establishedded cotrtracts widr the P'esbytery 2bout giving thd iflformztion. MoreoE, DeI had promised the niaisters corfidentiali+ COMMENTS: This subpdnciple rccogrizes that MFTi provide s€Fices to o$s for rhi.d prtiq. Id drse relztionships,boundariesale apt to becohe emeshed sincethe thnd paity has d inrstrnent in the senjces giv€' to othe.s. Indeed, it maybe dif6curt for MFTS to delineatetle primdy client. This p.inciple stipul,tes, rh€refore,that MI'I"S must drify t}te nature of the rel2tionship with eachpany as well6 the Imits of confid€nti,li+ L this example, DeU re into difficulties be causethe boud*ies rd expectationsin eachrelationshiF wde not cldifi€d prior ro bcgimi.g rc.L M& fie ninistds Moreovd, DeIt promise of confidenti,lity oEde it i@Fossiblefor De[ ro give dy informatioo back Io the Presbyterywhq in this cese,ws &e piimary dior. In the future, DeI ne€ds to ascertainwhat dre Presbrterydpecrs, who they €xpect iq vhat tley htend to do with th€ jnforoation, md what th€y have rold dle refdied p,Jties about their expectations-Theq De[ needsto cldit with the refe!rcd pdties tlle natue of Ddl's relationship with the Presbttery and th€ 6tent to which confidentitity cm be promised. Wrie lhiting confidenti.lity may.educe th€ shding of info(hation, tlE setting of reai istic bomddies protecrs th€ Deedsof,I p&ties dd ,llors De[ &e flexibility to move berwecn the thnd paty dd tne iefered pdties. Moreover, having cle,r bomdaries sets stadrds about what vil dd won't be alowed Such stmdards cu provide a senseof efety dd secwity to othes.