Ethics and professional issues in couple and family therapy PDF
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Ethics and ProfEssional issuEs in couPlE and family thEraPy Ethics and Professional Issues in Couple and Family Therapy, Second Edition, builds upon the strong foundations of the first edition. This new edition addresses the 2015 American Association for Marriage and Family Therapy Code of Ethics as well as other professional organizations’ codes of ethics, and includes three new chapters: one on in-home family therapy, a com- mon method of providing therapy to clients, particularly those involved with child protective services; one chapter on Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Health Information Technol- ogy for Economic and Clinical Health (HITECH) regulations that practic- ing therapists need to know; and one chapter on professional issues, in which topics such as advertising, professional identity, supervision, and research ethics are addressed. This book is intended as a training text for students studying to be marriage and family therapists. Megan J. Murphy, PhD, LMFT, is an associate professor and director of the Marriage and Family Therapy Program at Purdue University Northwest in Hammond, Indiana. She currently serves as a commissioner on the Com- mission on Accreditation for Marriage and Family Therapy Education and was a coeditor of Families Across Time: A Life Course Perspective (Oxford University Press, 2000). Lorna Hecker, PhD, LMFT, is a professor and director of the Couple and Family Therapy Center at Purdue University Northwest in Hammond, Indi- ana. She is Certified in Healthcare Privacy and Security expertise in HIPAA and HITECH regulations. She edited the first edition of E thics and P rofessional Issues in Couple and Family Therapy, and her previous publications include The Therapist’s Notebook: Homework, Handouts, and Activities for Use in Psychotherapy (Volumes 1, 2, and 3), The Therapist’s Notebook for Children and Adolescents, and An Introduction to Marriage and Family Therapy (Routledge). She also authored the book HIPAA Demystified: HIPAA Compliance for Mental Health Professionals (Loger Press). “The second edition of the Murphy and Hecker book is excellently writ- ten with illustrative case vignettes and is even more comprehensive than the original version. The additional chapters about HIPAA and HITECH, home-based therapy, and professional private practice issues make the book a must for all C/MFT training programs and private practitioners.” —Volker Thomas, PhD, LMFT, professor of couple and family therapy, University of Iowa (retired) “Ethics and Professional Issues in Couple and Family Therapy is full of pre- ventive care and interventions for couple and family therapists in clinical practice. The distinguished editors and contributors provide pages of prac- tical suggestions and recommendations to maintain best practices. The authors took great care to untangle complex ethical, legal, and technical issues, which makes the book an easy, but informative read for experienced clinicians and CFT students. The culturally diverse case examples illustrate how therapists can avoid common pitfalls inherent in clinical practice and the importance of self-care. This book should be a required reading for students in CFT programs!” —Stephanie Brooks, PhD, LCSW, LMFT, chair, Couple and Family Therapy Department; associate dean, Graduate Health Professions, Drexel University “This is an indispensable resource on ethical issues in the practice of couple and family therapy. The second edition includes a comprehensive review of new HIPAA and HITECH regulations, and the latest AAMFT code of ethics. Clear and concrete examples are used to drive home major points. I highly recommend this book to any couple and family therapy student, instructor, or licensed provider.” —Andrea K. Wittenborn, PhD, graduate director, associate professor, Human Development and Family Studies, Michigan State University Ethics and ProfEssional issuEs in couPlE and family thEraPy second Edition Edited by Megan J. Murphy and Lorna Hecker Second edition published 2017 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2017 Taylor & Francis The right of Megan J. Murphy and Lorna Hecker to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. The purchase of this copyright material confers the right on the purchasing institution to photocopy pages which bear the photocopy icon and copyright line at the bottom of the page. No other parts of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. First edition published by Routledge 2009 Library of Congress Cataloging-in-Publication Data Names: Murphy, Megan J., editor. | Hecker, Lorna L., editor. Title: Ethics and professional issues in couple and family therapy / edited by Megan J. Murphy and Lorna Hecker. Description: Second edition. | New York, NY: Routledge, 2017. Includes bibliographical references and index. Identifiers: LCCN 2016019391 | ISBN 9781138645257 (hbk: alk. paper) | ISBN 9781138645264 (pbk: alk. paper) | ISBN 9781315628240 (ebk) Subjects: LCSH: Family psychotherapy—Moral and ethical aspects. | Marital psychotherapy—Moral and ethical aspects. | Family therapists—Professional ethics. | Marriage counselors—Professional ethics. Classification: LCC RC488.5 .E87 2017 DDC 616.89/1562—dc23 LC record available at https://lccn.loc.gov/2016019391 ISBN: 978-1-138-64525-7 (hbk) ISBN: 978-1-138-64526-4 (pbk) ISBN: 978-1-315-62824-0 (ebk) Typeset in Minion Pro by codeMantra Contents Preface vii 1 Introduction 1 Lorna Hecker and Megan J. Murphy 2 Ethical Decision-Making from a Relational Perspective 17 Elisabeth Shaw 3 Legal Issues in Couple and Family Therapy 37 Ruth Ogden Halstead and John H. Halstead 4 The Impact of HIPAA and HITECH Regulations on the Couple and Family Therapist 59 Lorna Hecker, Courtney L. Miner, and Megan J. Murphy 5 Self of the Therapist: Being Aware, Prepared, and Ethical 81 Jared A. Durtschi and Melanie McClellan 6 Power, Privilege, and Ethics in Couple and Family Therapy 99 Megan J. Murphy and Lorna Hecker 7 Sexuality, Boundaries, and Ethics 121 Teresa L. Young and René A. Jones 8 Risk Management in Practice 141 Amber Sampson 9 Spirituality and Religion 163 Rebecca A. Cobb, Jacob B. Priest, and Taimyr B. Strachan 10 Ethics in Therapy with Children in Families 183 Lorna Hecker and Catherine Ford Sori 11 Ethical, Legal, and Professional Issues in Mediation and Parent Coordination 205 Julia M. Bernard, Nicole Manick, and Maike Klein v vi Contents 12 Ethical Issues in Clinical Practice 223 Z. Seda Sahin and Julie Ramisch 13 Ethical Issues with Systemic and Social Constructionist Family Therapies 243 Joseph L. Wetchler and Rachel M. Moore 14 Ethical Couple and Family E-Therapy 261 Markie L. C. Twist and Katherine M. Hertlein 15 Ethical and Clinical Considerations for Home-Based Family Therapy 283 Kiran M. Hussain, M. Evan Thomas, Shannon Polezoes, and Léa El Helou 16 Ethics of Professionalism 299 Megan J. Murphy and Amber Sampson Index 319 Preface Primum non nocere—First, do no harm. Hippocrates (c. 460–400 BC) You likely chose the field of couple and family therapy because of a desire to help people and would likely be aghast at the notion of harming your clients. Yet without proper knowledge, you can make decisions that can indeed cause harm to clients, your own professional practice, the larger professional field, and yourself. The chapters in this book have been c hosen to educate you on the most salient topics regarding the intertwining of ethical, legal, clinical, and professional issues faced by couple and family therapists. This book is a revision on the first edition, edited by Hecker in 2010. This book grapples with contemporary ethical and professional issues, some of which have changed or recently arisen or transformed since that writing. For example, in this edition, linear decision-making is replaced with a relationally focused ethical decision-making process that relies much more on clients’ context and the responsibilities therapists have to consider when making ethical decisions with clients. Power and privilege issues have been updated to include a focus on power issues that arise in choice of our theories, the therapeutic relationship, and in clients’ relation- ships with each other. The power of a therapist with regard to maintaining sexual boundaries and how to handle sexual harassment is detailed. The complexity reflected in intersectionality is introduced. A new standard of care has arisen with privacy protections for our cli- ents’ oral, written, or digital private information, with the advent of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as well as the subsequent Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. HIPAA audits were mandated by HITECH, and lawsuits are beginning to occur using HIPAA regulations as the standard of care for client privacy protection, whether or not you vii viii Preface are a “covered entity” under the regulations. HIPAA security regulations stress the importance of maintaining privacy of digitally stored client data, which can be overlooked by more of us who favor “high touch” over “high tech.” Specific information around ethical issues within e-therapy is also discussed, with a framework from which to conceptualize e-therapy clini- cal and ethical issues presented. Couple and family therapists’ entwinement with the legal system is explored, educating the reader on properly responding to a subpoena, while still focusing on the ever-important duty to warn or protect. Additionally, career opportunities that intersect with the legal system such as the role of a couple and family therapist as mediator and parent coordinator are explored. As we look at CFT involvement with custody issues on children, we also address the increasingly recognized phenomenon of parental alienation from a child. In our first edition, office policies and procedures were explained; in this book, we also delve into requirements to establish a private practice, including information on opening a business, applying to insurance pan- els, and necessary documentation. We recognize that more and more therapists are providing in-home family therapy, which evokes particular attention to ethical principles, including confidentiality, boundaries, and safety. Self-of-the-therapist issues are addressed and include knowing one’s own values, implement- ing a program of self-care, and warning signs for burnout and compassion fatigue. Finally, we have added a chapter on ethics of professionalism—to remind us that we represent our professional fields through our actions and behaviors. We are indeed connected to something larger than our- selves—the field of family therapy. This is a book for professionals who want to understand the context of complex situations in which couple and family therapists find themselves. It is a book for couple and family therapists who, consistent with their sys- tems training, will grasp multilevel problems, grapple with them, and go through a reasoned analysis to find a solution that best meets the needs of the people involved. As in the 2010 edition of this book, readers are introduced to ethical principles for consideration in ethical deliberation and decision-making. In an ideal world, all therapists would be trained in moral philosophy; that ideal is clearly outside the scope of this book. This book can be used as an introductory graduate text in marriage and family therapy graduate programs, professionals wishing to expand their depth and understanding of the field, or by those refreshing their knowledge of professional issue and ethics for licensing exams. Preface ix You will no doubt have quandaries when faced with ethical dilemmas posed in this book. Answers to ethical dilemmas often introduce com- plexity for which answers to those dilemmas also result in a refrain of “it depends.” Many variables contribute to evaluation when making sound ethical decisions. A tolerance of ambiguity is necessary for anyone who truly wishes to struggle with ethical dilemmas. You have to be able to juggle many diverging solutions (and viewpoints) at once before the best action can be chosen. Sometimes the best solution is obvious; other times, there are competing “best” courses of action. Sometimes, all alternatives to an ethical dilemma simply are not satisfying or can even be repugnant. Early foreclosure on decisions to decrease your accompanying anxiety can lead to situations (ethical, clinical, or legal) that are worse than the pre- dicament that was initially raised. Although some ethical/clinical decisions need to be made quickly, there are many situations in which the therapist can decelerate the process to thoroughly scrutinize the situation at hand. In this book, you will find numerous case scenarios, many based on actual experiences to give the reader a sense of the richness of ethical issues that may present themselves in therapy. In some, the ethical or legal issues at hand may be quite evident, whereas in others it may be subtle and you will need to search for the shades of gray that continuously make ethics a challenging but worthwhile pursuit. All case scenarios have had identify- ing information of the clients and case-specific information altered to pro- tect the confidentiality of the client. Unfortunately, in our personal experience, we have encountered thera- pists who have not followed the “do no harm” dictate and have hurt people when they violate their professional and moral responsibilities. In some circumstances, there has been egregious harm. We have seen others believe that they are without moral fault—this alone is a dangerous stance. The people who believe themselves to be without moral fault put themselves outside the realm of dialogue, and relationships become secondary to their agenda. Dialogue is key to resolving most ethical dilemmas. It our hope that you engage in much dialogue as you traverse this book. It is our quest, then, that therapists be educated about ethics for the very positive goal of helping clients, but at the very least, Primum non nocere. This book pro- vides education, insight, and tools to help you adequately prepare for ethi- cal practice as a couple and family therapist.
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