Ethical, Legal, and Professional Issues in the Practice of Marriage and Family Therapy

By
By S. Allen Wilcoxon, Theodore P. Remley, Jr., Samuel T. Gladding, Charles H. Huber

Course Description

VALUES AS CONTEXT FOR THERAPY

This best-selling text examines the cultural, ethical, legal, and professional issues of marriage and family therapy using values as a beginning point for practice decisions. Organized in a four-part format, the book includes current cultural issues; examines ethical codes, problems, and domains; offers perspective on the latest legislation, and discusses issues of professional identity. Three chapters devoted to case studies add context and illustrate the complexities inherent in marriage and family therapy. One of these “casebook” chapters addresses ethical issues (Chapter 7), one deals with legal issues (Chapter 10), and one looks at professional issues (Chapter 12).

In this fourth edition learn more about:

  • The personal, professional, and institutional layers of values affecting marriage and family therapists
  • Culturally responsive marriage and family therapy
  • The impact and use of technology in marriage and family therapy
  • The Health Insurance Portability and Accountability Act (HIPAA) and its influence on marriage and family therapy practice

About Authors

S. ALLEN WILCOXON is professor and coordinator of the Program in Counselor Education at the University of Alabama. He is a Licensed Professional Counselor in the states of Alabama and Washington, a Clinical Member and Approved Supervisor with the American Association for Marriage and Family Therapy, and a Nationally Certified Counselor. Dr. Wilcoxon holds a B.A. in Religion and Philosophy from Ouachita Baptist University, an M.A. in Psychology from Stephen F. Austin State University, and an Ed. D. in Counselor Education from East Texas State University (now Texas A&M University-Commerce). His postdoctoral work was at Texas A & M University. He is the author of numerous publications related to marriage and family therapy, clinical supervision, and ethics in mental health care. He is former chair of the Alabama Board of Examiners in Counseling. He is married to Dr. Pat Harrison, Professor of School Psychology at the University of Alabama. Their sons, Buz and Andy, are currently completing their graduate and undergraduate careers, respectively. He enjoys fishing, traveling, and baseball played at any level.

THEODORE P. REMLEY, JR., is a professor of counseling and holds a Batten Endowed Chair at Old Dominion University in Norfolk, Virginia. He is a member of the bar in Virginia and Florida and is licensed as a Professional Counselor in Louisiana, Mississippi, and Virginia, as well as a Licensed Marriage and Family Therapist in Louisiana. He is also a National Certified Counselor. Dr. Remley holds a B.A. in English, an M. ED., and Ed.S., and a Ph.D. in Counseling from the University of Florida, and a J.D. from Catholic University in Washington, D.C. Dr. Remley is the Coauthor with Barbara Herlihy of Ethical, Legal and Professional Issues in Counseling. In addition, he has edited and written books and monographs, book chapters, and numerous articles in professional journals on the topic of legal issues in mental health. He is a former Executive Director of the American Counseling Association and was founding president of the American Association of State Counseling Boards. He has served on the counselor licensure boards in Louisiana, the District of Columbia, Mississippi, and Virginia. Dr. Remley is a former officer of the Mardi Gras Krewe of Orpheus in New Orleans and directs an annual counselor study abroad program in Italy.

SAMUEL T. GLADDING is a professor in and chair of the Department of Counseling at Wake Forest University. He is a Licensed Professional Counselor in the state of North Carolina, a National Certified Counselor, and a National Certified Mental Health Counselor. Dr. Gladding is a Clinical Member and Approved Supervisor in the American Association for Marriage and Family Therapy. Dr. Gladding received a B.A. and M.Ed. from Wake Forest University, and M.A.R. from Yale University and his Ph.D. from the University of North Carolina at Greensboro. He is the author of numerous publications, including Family Therapy: History, Theory, and practice (4th ed.). He is past president of the American Counseling Association, a former editor of the Journal for Specialists in Group Work, and a past president of the Alabama Association for Marriage and Family Therapy. Dr. Gladding is married to the former Claire Tillson. They are the parents of three children. As a family they enjoy travel, humor, and attending athletic and artistic events.

CHARLES H. HUBER is on the faculty in the Department of Counseling and Educational Psychology, New Mexico State University. A licensed psychologist in the states of Connecticut, Florida, and New Mexico, he also holds diplomas in family psychology and behavioral psychology with the American Board of Professional Psychology. In addition Dr. Huber is a clinical member and approved supervisor for the American Association for Marriage and Family Therapy and an approved supervisor and fellow of the Institute for Rational Emotive Behavioral Therapy. He maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, New Mexico. Dr. Huber received his B.A. from Upsala College, M.Ed. and Ed.S. from Florida Atlantic University, and Ph.D. from the University of South Carolina. He has authored or co-authored 10 books, served as editor of several professional journals, and written numerous articles and book chapters. He is active in a number of professional organizations, most recently serving as president of the New Mexico Association for Marriage and Family Therapy. Dr. Huber has been married for over two decades to his partner, Betsy. They and their two children raise and train Labrador retrievers as their family hobby.


Learning Objectives

After completing this course you’ll be able to:

  1. Discuss the internal and external factors as depicted.
  2. Describe values as stated by Rokeach.
  3. Compare the two value-based decisions and discretionary actions.
  4. Define culture, subculture, and intraculture.
  5. State the terms of sexual orientation as described by MacGillivay (2000).
  6. Compare core and contextual factors from the Model of Multiple Dimensions of Identity from Figure 1-6.
  7. Define novelty, dissonance and integration.
  8. Discuss value clarification and value-sensitive care.
  9. Describe the concept of recognizing limitations.
  10. Discuss valuing values, valuing uniqueness, and valuing reality.
  11. List the derivatives of duty according to Dell (1983).
  12. State the four implications of value-sensitive care according to Table 1-1.
  13. Discuss the duties of the therapist.
  14. Define epistemology, psychological worldview, and systemic worldview.
  15. Discuss the object relations theory.
  16. Describe institutional values.
  17. Discuss three forms of power.
  18. List examples of “recoupling.”
  19. Discuss autonomy, beneficence, justice, fidelity, and nonmaleficence.
  20. Compare the Kidder Model, the Kitchner Model and the Koocher and Keith-Spiegel Model.
  21. Define competence and due care.
  22. Define confidentiality, privileged communication and privacy.
  23. Discuss informal consent.
  24. State the three types of secrets (Karpel).
  25. Discuss goal setting according to M.P. Nichols (2008).
  26. Compare inequities and imbalances.
  27. Compare deterioration and relapse.
  28. Discuss the two aspects of enabling.
  29. Describe the paradoxical procedure.
  30. State the data from the CDC (2009) regarding intimate partner violence.
  31. List the four interrelated clinical positions to ensure ethical practice according to Willbach.
  32. Compare the DSM approach with marriage and family therapy when locating a presenting problem.
  33. Discuss “insurance diagnosis.”
  34. Describe third-party payment arrangements.
  35. State the reasons dual relationships are problematic.
  36. Compare the synchronous and asynchronous format in technology.
  37. Describe technology-based therapy.
  38. Discuss the Tarasoff criteria in an AIDS-related therapeutic situation.
  39. State the five major steps in handling complaints of unethical behavior by AAMFT members from Figure 9-1.
  40. List the eight principles of the AAMFT Code of Ethics and briefly describe each.
  41. Define common law, constitutional law, statutory law and administrative law.
  42. List the five components which are helpful in interpreting court decisions.
  43. Discuss the three factors in the duty to protect from the Tarasoff decision.
  44. Define child abuse.
  45. Discuss the roles of the therapist as a diagnostician, resource expert, and treatment provider.
  46. List the five stages of the mediation process.
  47. Define direct examination, cross examination and redirect examination.
  48. List the four key elements that must be present to prove malpractice.
  49. List several reasons for an increase in cohabitating couples.
  50. Discuss the process of adoption.
  51. Compare annulment and divorce.
  52. Describe the four forms of child custody.
  53. State how marriage and family therapists should seek legal advice.
  54. Define a minor.
  55. Describe the Family Educational Rights and Privacy Act (FERPA).
  56. Describe the four types of waivers as stated by Knapp and Vandercreek (1985).
  57. Define personal affiliation and licensure.
  58. Describe the various membership categories within AAMFT.
  59. List several temptations and their risks made by graduating students and novices.
  60. State the five major premises that support licensure efforts according to Fretz and Mills (1980) and the critics response.
  61. Discuss the importance of continuing education.
  62. Discuss practice issues and precedents.
  63. Discuss the research of May and Church (1999).
  64. Describe the aspects of the simplified checklist from principle 8 for Marriage and Family Therapists.
  65. State how to discontinue a practice.

Course Contents

Part I Acculturation, Worldview, and Value-Sensitive Care: Foundations for Practice Decisions

Chapter I VALUES AS CONTEXT FOR THERAPY Why Begin with Values? Culture, Worldview, and Identity

Gender

Ethnic/Racial Heritage

Social Class or Socioeconomic Status

Sexual Orientation

Disability

Religious/Spiritual Traditions

Other Cultural Dimensions

Worldview

Psychosocial Identity, Meaning Making, and Context

Stability, Dissonance, and Integration

Value-Sensitive Care: Preliminary Therapist Concerns

Value Clarification as a Prelude to Value-Sensitive Care

Respecting Cultural Differences in Value-Sensitive Care

Other Concerns in Value-Sensitive Care

Implications of Value-Sensitive Care

Implications of Context

Implications for Therapist Roles and Duties

Implications for the Process of Therapy

Implications for the Goals of Therapy

Summary

Recommended Resources       

Chapter II PROFESSIONAL ACCULTURATION AND THE ECOLOGY OF THERAPY

Systemic Epistemology as a Professional Worldview

      The Feminist Critique of Systemic Epistemology

      The Self in the System

      Evolving Epistemologies

Values and Power: The Foundations of Influence

      Layers of Values

      Forms of Power

Personal and Professional Acculturation in the Ecology of Therapy

      Summary

PART II Ethical Issues in Marriage and Family Therapy 

Chapter 3    PROMOTING ETHICAL PRACTICE: PRINCIPLES, TRADITIONS, AND CONSIDERATIONS

Foundational Principles and Professional Codes

      Mandatory Actions from Ethical Codes

      Discretionary Actions from Ethical Codes

Ethical Decision Making

      The Kitchner Model

      The Koocher and Keith-Spiegel Model

Client Welfare

      Therapist Competence

      Due Care

      Complementary Elements: Competence and Due Care

      Impairment

Confidentiality

      Privileged Communication

      Privacy

      The Duty to Protect

Informed Consent

      Therapeutic Contracts

      Professional Disclosure Statements

            Summary

            Recommended Resources

Chapter 4  UNIQUE ETHICAL CONSIDERATIONS IN MARRIAGE AND FAMILY THERAPY: PRINCIPLE DISTINCTIONS

Foundational Ethical Principles in Marriage and Family Therapy: New Complexities

      Multiple Client Considerations

      Confidentiality in Marriage and Family Therapy

      Privileged Communications in Marriage and Family Therapy

      Informed Consent Concerns in Marriage and Family Therapy

Defining the Problem and Establishing Goals Inequity and Imbalance in Marriage and Family Therapy

      Summary

      Recommended Resources

Chapter 5  UNIQUE ETHICAL CONSIDERATIONS IN MARRIAGE AND FAMILY THERAPY: PRACTICE DISTINCTIONS

The Therapist as Agent for Change

Complications in Convening Multiple Clients

Paradoxical Procedures in Multiple Client Care

Other Uniquenesses in Marriage and Family Therapy

      Summary

      Recommended Resources

Chapter 6 INTIMATE PARTNER VIOLENCE AND THE ECOLOGY OF THERAPY

Intimate Partner Violence: An Overview

Cultural, Value-Power, and Systemic Considerations

Principles, Traditions, and Uniquenesses

Decision-Making Models and Options for Resolution

Treatment Alternatives: Choices and Stipulations

Chapter 7 CONTEMPORARY ETHICAL ISSUES: CONTEXTUAL MATTERS

Meta-Issues of Context: Opportunities, Vulnerabilities, and Exceptions

The Diagnostic and Statistical Manual of Mental Disorders and Its Use in        

Marriage and Family Therapy

      Incompatibility of Orientations

      The Stigma of Diagnosis

      Misrepresentation of Diagnosis

      Competence to Diagnose

Managed Mental Health Care

      Risk Taking

      Intrusion into the Therapeutic Relationship

      Exceptions to the Rules

      Referral Resources

      Short-Term Treatment and Therapist Competence

      Input by Service Providers

      Informed Consent

      Acting Ethically as a Service Provider

Institutional Values and Legal Duty in Conflict with Professional Values

      Summary

      Recommended Resources

Chapter 8 CONTEMPORARY ETHICAL ISSUES: PRACTICE MATTERS

Multiple Relationships with Clients or Others

      Ethical Codes and Multiple Relationships

      Compatibility of Expectations

      Divergence of Obligations

      Power and Prestige Differential

      Other Forms of Multiple Relationships

      Taking Appropriate Action

Technology

      Technology in Information Management

      Technology as a Practice Resource

      Technology as Therapeutic Modality

      Ethical Issues in the use of Technology: Concerns for the Ecology of Therapy

HIV/AIDS, Confidentiality, Client Welfare, and Public Protection

      A Fiduciary Relationship

      Identifiability

      Forseeability

      Low-Risk Behaviors

      High-Risk Behaviors

      Intermediate-Risk Behaviors

      Other Factors and Considerations

      Taking Appropriate Action

Research and Publication: Informing Ethical Practices

      Summary

      Recommended Resources

Chapter 9 ETHICAL ACCOUNTABILITY: A CASEBOOK

Adjudication of Ethical Complaints

The AAMFT Code of Ethics

      Principle 1: Responsibility to Clients

      Principle 2: Confidentiality

      Principle 3: Professional Competence and Integrity

      Principle 4: Responsibility to Students and Supervisees

      Principle 5: Responsibility to Research Participants

      Principle 6: Responsibility to the Profession

      Principle 7: Financial Arrangements

      Principle 8: Advertising

            Summary

Part III  Legal Issues in Marriage and Family Therapy

Chapter 10  THE MARRIAGE AND FAMILY THERAPIST: ROLES AND RESPONSIBILITES WITHIN THE LEGAL SYSTEM

      Legal Education

            Common Law

            Constitutional Law

            Statutory Law

            Administrative (Regulatory) Law

            Case Law (Court Decisions)

            Criminal Versus Civil Law

      The Marriage and Family Therapist as a Source of Information

            Confidentiality, Privileged Communication, and Records

            The Duty to Protect

            Child Abuse and Neglect

      The Marriage and Family Therapist as a Referral Resource

            The Treatment Specialist

            Diagnostician

            Resource Expert

            Treatment Provider

            Mediation

      The Marriage and Family Therapist as Expert Witness

            The Rules of Evidence

            Courtroom Testimony

      Professional Liability Under the Law

            Contract Law

            Unintentional Torts: Malpractice

            Intentional Torts

            Professional Liability Insurance

                  Summary

                  Recommended Resources

Chapter 11  FAMILY LAW 

      Marriage and Cohabitation

      Parent-Child Relationships

            Legitimacy and Paternity

            Adoption

            Surrogate Parenthood

            Abortion

      Parental Rights and Responsibilities

      Annulment and Divorce

            Annulment

            Divorce

            Spousal Maintenance

            Division of Property

      Child Custody and Support After Divorce

            Child Custody

            Child Support

      Legal Actions Between Parents and Children

            Summary

            Recommended Resources

Chapter 12  LEGAL CONSIDERATIONS

      Case 1: Ethics and the Law

      Case 2: Divorce Mediation

      Case 3: Liability in Crisis Counseling

      Case 4: Informed Consent?

      Case 5: Criminal Liability

      Case 6: Parental Rights and FERPA

      Case 7: The Premarital Agreement

      Case 8: Privileged Communications

      Case 9: Legal Responsibility of Clinical Supervisors

      Case 10: Insurance Fraud?

Part IV  Professional Issues in Marriage and Family Therapy

Chapter 13  PROFESSIONAL ISSUES: IDENTITY, AFFILIATION, TRAINING, AND TRANSITIONS AS A MARRIAGE AND FAMILY THERAPIST 

      Professional Identity: Who Am I?

            Profession or Specialization? Field or Form? Basic Premises of Professional Identity

            Marriage and Family Therapy as a Separate and Distinct Profession

            Marriage and Family Therapy as a Professional Specialization

            Is Balance Possible?

      Professional Affiliation and Training: Who Are We?

            American Association for Marriage and Family Therapy

            American Family Therapy Academy

            The Society for Family Psychology (Division 43 of the American Psychological Association)

            International Association of Marriage and Family Counselors

      Transitions: What are My Next Steps?

            Summary

            Recommended Resources

Chapter 14  PROFESSIONAL ISSUES: SUPERVISION, LICENSURE, AND PROFESSIONAL DEVELOPMENT AS A MARRIAGE AND FAMILY THERAPIST

      Supervision: What Do I Do?

      Marriage and Family Licensure: What Can I Do?

            The Scope of Licensure Privilege

            Qualifications

            The Licensure Process

      Professional Development: What’s Next for Me?

            Research: Examining and Refining Professional Development

            Continuing Education: Sustaining and Renewing Professional Development

            Intraprofessional Relationships and Service: Expanding and Enriching Professional Development

                  Summary

                  Recommended Resources

Chapter 15  CONTEMPORARY PROFESSIONAL ISSUES: QUESTIONS AND RESPONSES   

      QUESTION 1: Evolving Epistemology in Actual Practice

      QUESTION 2: Values Transactions

      QUESTION 3: Professional Advertising

      QUESTION 4: Practice Interruptions

      QUESTION 5: Fees and Business Expenses

      QUESTION 6: Independent Practice in a Rural Area

      QUESTION 7: Being a “Public” Marriage and Family Therapist

      QUESTION 8: Optimally Serving Oneself and One’s Clients

      Closing Thoughts and a View to the Horizon

Appendix A         AAMFT Sample Privacy Document

Appendix B         AAMFT Sample Office Practices Document

References

Name Index

Subject Index