Ethical Issues in Couples and Family Therapy by yaofenjin

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									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…



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   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.

								
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