pp 10 min

10.1177/1066480703252339 ARTICLETHE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / July 2003Fall, Lyons / ETHICAL CONSIDERATIONS

❖ Ethics

Ethical Considerations of Family Secret

Disclosure and Post-Session Safety Management

Kevin A. Fall

Christy Lyons

Loyola University—New Orleans

The ethical issues involved in the disclosure of family secrets in ther-

apy have been addressed in the literature, but the focus has typically

been on secrets disclosed in individual sessions. The literature

largely ignores the ethical issues surrounding in-session disclosure

and the concomitant liability of the family therapist for the post-ses-

sion well-being of the system’s members. This article explores types

of family secrets, provides a case example of in-session disclosure,

and presents ethical considerations and practice recommendations.

Keywords: family secrets; ethics; confidentiality; abuse; safety

A family without secrets is like a two-year-old without

tantrums: a rarity. Virtually every family has secrets

involving academic problems, relationship dynamics, or even

various illegalities. Secrets permeate the family system

before therapy begins, but with the introduction of the thera-

pist, the system begins to change. The therapist ideally creates

an environment that challenges the boundaries and rules of

the system; this is the nature of therapy. As a result of the

sense of safety within the session, it is conceivable that a fam-

ily member may disclose information that has been hidden for

a wide variety of reasons. Any unearthing of hidden material

will create a disequilibrium within the system. Family thera-

pists are trained to handle the consequences of such a disclo-

sure in session and ethically lay the groundwork for timely

disclosures. Dealing with this disclosure and its impact on the

system often becomes the primary focus of the therapy, as the

perturbation caused by the disclosure can serve as a catalyst to

reorganize the system.

However, not all information is disclosed at the “perfect

time.” In fact, the idiosyncratic internal sensing of safety by

any member of the family may trigger a disclosure prema-

turely. Secrets are such an omnipresent dynamic in the life of

family systems that it seems unlikely that any family therapist

could avoid untimely disclosures. Even in these unpredict-

able moments, a disclosure creates a disequilibrium that can

be productive in the therapy process as the secret and the pro-

cess of maintaining the secret are worked through in an

atmosphere of trust and safety. The ethical question here is

two-fold: What is the therapist’s responsibility in preparing

the family members for the potential risks of counseling that

may arise from such disclosures, and what is the responsibil-

ity of the family therapist to maintain the safety of the mem-

bers after a disclosure?

Although the International Association of Marriage and

Family Counselors’ (IAMFC) ethical code and current litera-

ture have begun to surface and solidify some approaches to

handling secrets disclosed by family members in concurrent

family and individual counseling (e.g., whether information

about an affair disclosed in an individual session can or

should be disclosed in a couple’s or family session) (Brendel

& Nelson, 1999; Brock & Coufal, 1994; IAMFC, 2002;

Watkins, 1989), the literature largely ignores the ethical

issues surrounding in-session disclosure and the concomitant

liability of the family therapist for the post-session well-being

of the system’s members. This article explores the types of

family secrets and processes a case example of a premature

disclosure using the International Association of Marriage

and Family Counselors’ ethical code accompanied by prac-

tice recommendations.

Types of Family Secrets

Karpel (1980) described three major types of family

secrets based on the kinds of boundaries created in the family

system: (a) shared family secrets (secrets kept by the whole

family), (b) internal family secrets (secrets kept by some fam-

ily members), and (c) individual secrets (secrets kept by an

individual member of a family). Vangelisti (1994), a commu-

nications specialist, conducted a factor analysis that ulti-

mately divided family secrets into three additional categories

that should be useful in the present discussion: taboo topics,

rule violations, and conventional secrets. Conventional

281

THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES, Vol. 11 No. 3, July 2003 281-285

DOI: 10.1177/1066480703252339

© 2003 Sage Publications

secrets are those considered inappropriate for conversation,

such as personality conflicts, death, religion, academic per-

formance, and physical health problems. Rule violations are

secrets about violations of some accepted norm of conduct,

such as sexual relations, premarital pregnancy, cohabitation,

drinking, and breaking rules. Taboo topics are those that are

seen as disreputable to society or to family members and

include secrets about extramarital affairs, divorce, mental

health, illegal behavior, substance abuse, and physical or psy-

chological abuse (Vangelisti, Caughlin, & Timmerman,

2001).

Problems With Family Secrets

If most healthy families have secrets, why should family

secrets pose an ethical concern for family therapists? The

concern becomes not if the family has a secret, but what

impact will the disclosure of the secret have on the family?

Different types of secrets can cause varying degrees of imbal-

ance, and therapists must also consider history and context.

Consider this example of an internal-conventional secret:

“Don’t tell Dad how much money we spent today.” Although

hiding this information from Dad is clearly not the healthiest

response to the situation, standing alone, it is not likely to lead

to severe family problems if disclosed in a therapy session.

Admittedly, the issue becomes more complicated with the

addition of a pattern of financial distrust or abuse.

More severe problems arise when families begin keeping

rule violations secret and compound when taboo topics are

hidden. For example, if a mother keeps her teenage daughter’s

cohabitation with a boyfriend while at college a secret from

other family members (an internal-rule violation), the quality

of the relationships would likely be jeopardized. Internal-rule

violation secrets can create or strengthen boundaries and alli-

ances in the family (Karpel, 1980) that can ultimately lead to

triangulation, resulting in one pair of family members becom-

ing close and others becoming distant (Nichols & Schwartz,

2001). The alliance forged by the secret is reflected in the

relationships among the members in therapy, and the secret

may be prematurely disclosed as an act of loyalty, power, or

protection (Karpel, 1980). As the counselor attempts to con-

front the alliance, the probing might also act as a catalyst for

the disclosure.

Whereas internal-rule violation secrets can lead to prob-

lems such as triangulation within the family, shared family

taboo topic secrets can be more detrimental and potentially

lethal. Examples of these types of secrets include domestic

violence, child abuse, and chemical dependency. These are

the types of secrets that cause the greatest concern for the

family therapist when they are revealed within a family ses-

sion. For example, a child discloses in a family session that he

wishes his father would stop using drugs. The reaction of the

family makes it clear to the therapist that the child has just

revealed a tightly held shared family taboo topic secret.

Depending on the family and the situation, this disclosure

could potentially have negative consequences for the child

who revealed the secret once the family leaves the counseling

session.

When the family secrets surface, they can act as

disequilibriating forces within the system and, due to their

power, are often sought out by therapists eager to create and

promote change in the system. Due to the secret’s change

potential, therapists must also be aware of the damage it can

cause to the system. The potential problem can be exacer-

bated when the disclosure is premature and not expected by

the therapist, circumventing any groundwork and boundary

setting for the disclosure. The following case example and

discussion explore the ethical concerns that must be consid-

ered when a disclosure is made in session and the post-session

management involved.

Case Example

As a method for illuminating some of the ethical issues

involved in dealing with in-session family secret disclosures,

consider the following interchange between a supervisor and

supervisee:

Supervisee: I had the best session. Today the mom/wife spontaneously disclosed that she was dissatisfied with her life and, although she loved the children, had been having an affair for 6 months with a family friend (an individual, taboo topic secret).

Supervisor: Wow, how did the family handle the information?

Supervisee: It really shook them up . . . got them out of their comfort zones. Dad just got up and left. He seemed really embarrassed and even a little mad. The kids seemed stunned. Mom seemed relieved to have the secret out in the open. I spent the remaining 20 minutes of the session processing the disclosure. The mom said she hoped that therapy would give them all a chance to talk about this in an open way. In fact, she said that this was the main reason she had tried to get everyone to come in for therapy. She seemed disappointed that her husband was so upset.

Supervisor: How well do you know the husband? What do you think his reaction will be to the disclosure?

Supervisee: Well, this is only our third session, so I don’t know too much about him really.

Supervisor: I am concerned about the family’s ability to manage this new information. How did you process the possible fallout from the disclosure?

Supervisee: I never thought of that. I was so excited about the prospect of change that I never thought about the negative impact. The husband left so quickly, I did not have a chance to check on him, and I primarily focused on the mom the remainder of the session.

Most therapists would probably concur that the supervisee

was accurate in her assessment and intervention. The atmo-

sphere of the therapy session facilitated a disclosure that dis-

rupted the family homeostasis, a process that can lead to

282 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / July 2003

change. However, the supervisor is right to question the

impact the destabilization might have on the family outside

the therapy hour.

The main concern confronted in this scenario is the con-

flict between encouraging disclosure because it is viewed as

therapeutic and being responsible for the impact of the disclo-

sure outside of the session. In many cases, therapists may

focus so heavily on destabilizing the system that they forget

the impact the intervention may have on the family outside the

safe confines of the session hour. Although therapists cannot

and should not be responsible for what clients disclose in ther-

apy, one could argue that the creation of an atmosphere of

safety leads to the disclosure of the material and, thus, makes

the therapist responsible for managing the outcome. Brendel

and Nelson (1999) noted “The counselor is held directly

responsible for directing the flow, or lack thereof, of sensitive

information disclosed” (p. 113). If the counselor directs the

flow, then it is intuitive that the counselor also bear some

responsibility for managing the outcome.

Considering the impact of one’s interventions is not a new

concept to therapists. However, the family therapy commu-

nity has acknowledged a lack of research, discussion, and

training in the area of secret management (Imber-Black,

1993; Roberts, 1993), and the literature is even more silent

with regard to the therapist’s post-session responsibility for

safety management. Vesper and Brock (1991) accurately

summarized the problem by stating, “The therapist is faced

with a complex dilemma, because the role of treatment agent

is to elicit the client’s dark thoughts and desires” (p. 20). This,

coupled with the imperative to destabilize the system, may

lead to an accelerated desire to get clients to disclose the

information in session, sometimes prematurely. The remain-

der of this article will provide some guidelines and ethical

considerations for managing family secrets.

IAMFC Ethical Code

When confronted with a difficult clinical scenario, family

practitioners consult colleagues and the ethical code for

guidelines that may direct professional judgment. Unfortu-

nately, exploring the ethical code for specific reference to

how one might deal with the post-session safety issues

involved in family secrets disclosures proves limited at best.

The IAMFC ethical code (2002) does not make specific refer-

ence to this topic, so one must piece together other, more gen-

eral, ethical standards to formulate some basic parameters of

action. The relevant ethical issues involve front-end consider-

ations of informed consent and ongoing clinical and ethical

issues that involve beneficence and nonmaleficence

principles.

Informed consent refers to the “right of individuals to be

informed and make autonomous decisions about any treat-

ments they receive” (Bednar, Bednar, Lambert, & Waite,

1991, p. 133). Current ethics literature recommends that ther-

apists inform their clients of the techniques and theories uti-

lized, the potential risks of counseling, and any alternatives to

treatment (Margolin, 1982; Remley & Herlihy, 2001). The

IAMFC (2002) ethical standard with the closest relationship

to this topic can be found under section 1.N. “Members

inform clients (in writing if feasible) about the goals and pur-

pose of counseling, qualifications of the counselor(s), scope

and limits of confidentiality, potential risks and benefits of the

counseling process and specific techniques and interventions,

reasonable expectations for outcomes, duration of services,

costs of services, and alternative approaches.” Although this

standard does not uniquely address the issue of family secrets,

the standard provides therapists with the guidance that one

must consider the client’s autonomy when considering

courses of action. In family therapy, that autonomy is consid-

ered for every member of the system. In addition to the auton-

omy issue, the standard requires that in order for clients to

fully experience the right to choose, the clients must also

understand the possible consequences of the given choices. It

is the therapist’s responsibility to explore those conse-

quences. As Goldenberg and Goldenberg (2000) noted, “Fail-

ure to inform clients of possible risks runs the risk of malprac-

tice suits for negligence” (p. 414).

Ethical practice demands that members of the family must

be apprised of the nature of counseling, the aims of the sys-

temic approach, and the risks inherent in family counseling.

In considering the case of the client who disclosed the infor-

mation, she stated she did so because she felt that “it was

safe.” In truth, most if not all counselors strive to make the

counseling sessions feel safe or at least safer than the current

family environment. The rationale is that safety may lead to

an environment that can facilitate change. However, does that

safety exist once the session is over? Does the safety carry

over into the family life? Even more vital, do the clients

understand the difference between safety in their sessions and

safety outside their sessions, or is there just an expectation

that the safety of the therapy will create an isomorphic struc-

ture of safety outside the session?

Some practitioners might see this exploration as an

attempt to micromanage the family’s disclosures, usurp their

autonomy, or even worse, disarm a primary therapeutic tool.

To the contrary, emphasizing informed consent of possible

risks provides the client with the clearest view of the thera-

peutic process and educates them about the unique dynamics

of family therapy. It can be seen as a proactive boundary-

setting process that helps set realistic expectations for the

therapeutic process. To fulfill the ethical requirement of

informed consent, family practitioners are encouraged to

examine their professional disclosure statements and include

information about the risks of disclosure and difference

between in-session and “real world” safety, both psychologi-

cal and physical. Additionally, there is no evidence that a

clear presentation of the elements of informed consent and

acceptance of them by the family will dissuade or impede par-

ticipation in therapy. The goal is not to shut the family down

Fall, Lyons / ETHICAL CONSIDERATIONS 283

but to avoid disclosure that may be based on unrealistic

expectations about therapy or a lack of knowledge about the

process.

The absence of clear, informed consent creates risk to both

the family and the therapist, but even the presence of

informed consent does not mean that secrets will not be pre-

maturely or inadvisably disclosed in session. Theoretically, if

proper informed consent is given, it is possible that disclosure

of a secret could be grist for the therapeutic mill. However,

there are ethical caveats that need to be considered. Morrison,

Layton, and Newman (1982) identified the handling of family

secrets as one of four primary ethical dilemmas all family

therapists must consider. Morrison et al. (1982) noted that,

although the family secrets vary in typology and the severity

of the impact disclosure may be difficult to forecast, the fam-

ily therapist must make careful observations of the family

dynamics, consider the ethical way of proceeding, and take

measures to ensure the safety of all members of the system.

This seems like sound advice, but in the absence of concrete

ethical guidelines and the uncertainty of the disclosure’s

impact on the system, many practitioners are caught between

a therapeutic impulse to process the secret and a professional

directive to protect the safety of family members.

Ensuring the safety of the members becomes the primary

focus of the counselor after a disclosure is made in session.

The IAMFC ethical code (2002) states under section 1.O.

“Members refrain from techniques, procedures, or interven-

tions that place families or members at risk of harm. Coun-

selors should refrain from using intrusive interventions with-

out a sound theoretical rationale and full consideration of the

potential ramifications to families and members.” The litera-

ture contains many examples of how to manage the safety of

family members in session, but monitoring client welfare out-

side of the session is a more difficult dynamic. Family thera-

pists have emphasized the need to monitor client safety when

there is a threat to harm self or others, and although these con-

cepts have not been addressed with family secrets, therapists

are encouraged to view all disclosures of family secrets as a

potential safety concern. One reason therapists must be vigi-

lant about the potential danger of such disclosures is the

delayed impact it might have on the system. In the case exam-

ple, the father’s reaction was immediate but the children

seemed numb. The member who discloses the information

could also experience a change in reaction to the disclosure,

for example, the mother may feel initially relieved but may

go home and feel extremely guilty or ashamed. The family

therapist needs to implement assessment strategies to moni-

tor the safety in both overt possible threats to the members

(father) and covert or delayed possible threats (children or

mother).

CONCLUSION AND RECOMMENDATIONS

The purpose of this article is to highlight the ethical issues

involved when clients disclose family secrets in session. The

thesis is that secret disclosure can be beneficial, providing the

family therapist considers the issues of informed consent and

safety monitoring. Based on the literature, the following sug-

gestions are provided for future practice and research.

1. Make sure that your clients understand the nature of counsel-

ing and its inherent risks. Informing the family about the pro-

cess of therapy, the unique approach of family therapy, and

the potential risks involved is critical to the safety of family

members. Clients of family therapy need to be informed that

the safe climate in the therapy session cannot be guaranteed

outside of the session. In doing so, each client can freely

determine what and how much information to disclose. To

highlight the importance of informed consent, the IAMFC

ethics committee and future publication and research

endeavors could review the current code for possible areas

where it could be more specific on the topic of potential risks.

2. Make accurate assessments of boundaries within the family.

Many clients, much like the mother in the case, believe that

counseling is a place to “get it all out into the open.” The

question here is not if this statement is accurate, but when it is

accurate. Disclosure of intimate information is a process, one

that gives vital information about the boundaries of the sys-

tem. Assessment of boundaries can provide the therapist with

some red flags regarding the potential for premature disclo-

sure. Practitioners are urged to heed the encouragement of

Wendorf and Wendorf (1985) and remember that a system’s

dynamics are observable and can change both in session and

outside of session. Systems with diffuse boundaries can be

viewed with an increased risk, and more time can be spent on

easing them into the process with boundary-setting work.

From a systems’ perspective, good assessment of the system

can avoid the need for premature disclosure through the

working through of isomorphisms related to the secret within

the system (e.g., identifying and working through trust, inti-

macy, and communications issues may decrease the need for

the affair and its premature disclosure).

3. Be prepared to assess the impact of the disclosure of the sys-

tem. According to the IAMFC code of ethics, marriage and

family counselors must guard against the therapeutic excite-

ment of facilitating a disclosure at the expense of safety mon-

itoring and assessment. Family therapists are encouraged to

view all such disclosures as disequilibrating to the system

and should assess the system for threats to self or other and

organize interventions to match the assessment. In the case

example, what might be the conceivable outcomes? The pos-

sibilities are vast and range from the benign possibility of the

system being relieved by the disclosure and return ready to

work to the catastrophe of the father committing suicide,

homicide, or both. Ethical practitioners protect the safety and

well-being of the system, and although therapists cannot

(and should not) control what clients say, they do have an eth-

ical responsibility to modify interventions to address the

potential threat. Examples of possible interventions might

284 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / July 2003

include an increase in frequency or length of sessions, work-

ing with the subsystems, or referral to individual therapy.

These practical suggestions are a starting place for family

therapists concerned with the ethical consideration in han-

dling premature disclosure of family secrets in session. This

article has produced far more questions than answers, which

gives the family therapy community an opportunity to

explore this issue in more depth. As further exploration takes

place, perhaps more attention will be given to the ethical con-

siderations of family secrets, yielding additional practice

recommendations.

REFERENCES

Bednar, R. L., Bednar, S. C., Lambert, M. J., & Waite, D. R. (1991). Psycho-

therapy with high-risk clients. Pacific Grove, CA: Brooks/Cole.

Brendel, J. M., & Nelson, K. W. (1999). The stream of family secrets: Navi-

gating the islands of confidentiality and triangulation involving family

therapists. The Family Journal: Counseling and Therapy for Couples and

Families, 7, 112-117.

Brock, G. W., & Coufal, J. C. (1994). A national survey of the ethical prac-

tices and attitudes of marriage and family therapists. In G. W. Brock

(Ed.), American association for marriage and family therapy ethics case-

book (pp. 27-48). Washington DC: AAMFT.

Goldenberg, I, & Goldenberg, H. (2000). Family therapy: An overview.

Pacific Grove, CA: Brooks/Cole.

Imber-Black, E. (Ed.). (1993). Secrets in families and family therapy. New

York: Norton.

International Association of Marriage and Family Counselors. (2002). Ethi-

cal code. Board-approved draft.

Karpel, M. A. (1980). Family secrets: I. Conceptual and ethical issues in the

relational context. II. Ethical and practical considerations in therapeutic

management. Family Process, 19, 295-306.

Margolin, G. (1982). Ethical and legal considerations in marital and family

therapy. American Psychologist, 37, 788-801.

Morrison, J. K., Layton, D., & Newman, J. (1982). Ethical conflict in deci-

sion making. In J. C. Hansen & L. L’Abate (Eds.), Values, ethics, legali-

ties, and the family therapist (pp. 75-86). Rockville, MD: Aspen.

Nichols, M. P., & Schwartz, R. C. (2001). Family therapy: Concepts and

methods. Needham Heights, MA: Allyn & Bacon.

Remley, T. P., & Herlihy, B. (2001). Ethical, legal and professional issues in

counseling. Columbus, OH: Merrill/Prentice-Hall.

Roberts, J. (1993). On trainees and training: Safety, secrets and revelation. In

E. Imber-Black (Ed.), Secrets in families and family therapy (pp. 389-

410). New York: Norton.

Vangelisti, A. L. (1994). Family secrets: Forms, functions, and correlates.

Journal of Social and Personal Relationships, 11, 113-135.

Vangelisti, A. L., Caughlin, J. P., & Timmerman, L. (2001). Criteria for

revealing family secrets. Communication Monographs, 68, 1-27.

Vesper, J. H., & Brock, G. W. (1991). Ethics, legalities and professional prac-

tice issues in marriage and family therapy. Boston: Allyn & Bacon.

Watkins, S. A. (1989). Confidentiality: An ethical and legal conundrum for

family therapists. American Journal of Family Therapy, 17, 291-302.

Wendorf, D. J., & Wendorf, R. J. (1985). A systemic view of family therapy

ethics. Family Process, 24, 443-453.

Kevin A. Fall, Ph.D., LPC, LMFT, is chair and associate professor of the Department of Education and Counseling at Loyola Univer- sity—New Orleans. Dr. Fall’s research interests include ethics, domestic violence, and group work. He also maintains a clinical practice focusing on adolescents and their families.

Christy Lyons, Ph.D., LPC, LMFT, is an assistant professor in the Department of Education and Counseling at Loyola University-New Orleans. Dr. Lyons’ research interests include family therapy, play therapy, and multicultural issues in counseling and supervision. She also is active in private practice with children and their families.

Fall, Lyons / ETHICAL CONSIDERATIONS 285