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Ethical Issues in Couples and Family Therapy

Chapter 11

Find the peer whose birthday is closest to yours!

Review this PPT with your partner & Prepare to take a kahoot quiz together on this topic!

You Will likely fall into one of the following categories:

Those Who do NOT Intend to practice Family/Couples Counseling

Those Who plan to or would like to practice Family/ Couples Counseling

Discuss stories of Family and even Couples therapy as a school counselor. Discuss how similar issues may present themselves in College or Community settings.

School:

College

Similar issues as with school may occur but on a lower level

Typically parents don’t interact with college counselors but it does happen!

Students may experience relationship issues that enter into the counseling sessions

Community

Quite a few community counselors practice some form of family counseling

It’s important to identify the primary client- is the family coming in for support or to give you additional information about the individual client? Or are they actually coming in as a unit to receive counseling?

There’s often a family element to many types of counseling for addictions, eating disorders, and other specific mental health treatment interventions. However, often the individual is the client.

So if you don’t plan to work with couples or families…

Can you just skip this chapter???

No- why not?

There’s often a family element to many types of counseling for addictions, eating disorders, and other specific mental health treatment interventions. However, often the individual is the client.

My own example:

Have parents come in angry at a teacher, or a student (issues of triangulation where students try to get teachers and parents at odd with each other to serve their interests.

Parents come in and ask for advice on how to handle issues with their child

Custody battles

Parent/guardian who wants you to convince child to do something or change behaviors

For those who do not plan to practice Couples/family Counseling:

Keep in mind you will eventually end up counseling and/or consulting with a client’s family member, parent/Guardian, or significant other

It may occur where you Need to bring a family member or significant other into a counseling session

You need to understand how to professionally Handle these types of situations

You will need to know how to refer & encourage clients to attend Couples/family counseling when appropriate

For those who May Plan practice Couples/family Counseling:

Recognize limits of your training and your competency level (ACA C.2.a)

Seek out additional professional development and/or courses on couples and family counseling

Be knowledgeable of best practices

Be aware of ethical considerations

Seek supervised practice in this area

Why is Ethics of counseling families and couples important?

Issue of competency is key because Ethics are more complicated:

Confidentiality & Informed consent Is More Complex

Documentation is more complex

Who is the identified client? See CODES of Ethics on pages 424-425

Why is confidentiality different when working with families?

You must clearly define rules if an individual tells you something he/she may not want other family members to know

Counselors practicing couples and family counseling often have a “no secrets” rule. Why do you think this is the case? (gets too complicated when keeping secrets between individuals and families- could get confusing on what is secret vs. what is not, and could bias the counselor)

How would informed consent look different?

Needs to clearly define rules of confidentiality if information is shared individually vs. in a family session

Who determines the goals in counseling? What if family members have a different idea of what the goal should be?

Confidentiality in Couples and Family Therapy

Exceptions to confidentiality:

When mandated by law

When it is necessary to protect clients from harm to self or others

When family therapist is a defendant in a civil, criminal, or disciplinary action arising from therapy

When a waiver has been previously obtained in writing

See secrets article by Kuo

Informed Consent in Couples and Family Therapy

Before therapy begins, the counselor needs to give information to family members about:

Purpose of therapy

Typical procedures

Risks of negative outcomes

Possible benefits of therapy

The fee structure

Confidentiality/informed consent

Do not plan to practice:

Make it clear to family members of your confidentiality policy

What would you say if family member wants to share a secret with you?

What you would say if family member wanted you to share something confidential about individual sessions?

May Plan to Practice:

Have a clear confidentiality policy that identifies what would occur if you have separate sessions with a family member

What would you include in your policy?

See Codes of Ethics to help with your answer

Find a partner as discussed earlier and discuss how you will handle confidentiality/writing an informed consent through one of these two lenses.

Answer the questions in the box that fits your lens.

Why is Ethics of counseling families and couples important?

Family values come into play. For example, consider the following values:

Divorce

gender RoleS

sexuality

Gender identity

Spirituality

Addiction

Mental illness

And more…

Divorce- are you for or against? Either way your values can impact your counseling.

Gender roles- what do you believe is an appropriate role for someone in relation to their gender within a family? What should young boys be able to do versus young girls

Sexuality- should couples have sex only within a union? Should parents allow their children to have sex?

Gender identity- how should a boy look or act? How should a girl look or act? How should parents treat children or significant others struggling with gender identity issues?

Religion- should children be required to prescribe to the religion of their parents? Should children have some sort of spirituality upbringing?

Addiction- how should families treat a member with addiction problems? What is your view on addiction and how might that be similar or different from other views?

Mental illness- same as addiction

Others?

Family Values

Discuss with a peer:

Consider your setting and discuss how family values may come into play

What are some family values you hold that might conflict with clients’ values at your setting?

How can you keep your values from impacting your work with clients and/or their families?

Why is Ethics of counseling families and couples important?

Competency needs to be carefully evaluated

Coursework & supervision must be tailored to train for couples/family counseling

Competency & FL Statutes

LMHCs are allowed to provide “Mental health counseling… to individuals, including individuals affected by the termination of marriage, and to couples, families, groups, organizations, and communities.” (Fl 491.003: 9A)

However, FL statute also states: “The use of specific methods, techniques, or modalities within the practice of marriage and family therapy is restricted to marriage and family therapists appropriately trained in the use of such methods, techniques, or modalities.” (Fl 491.003: 9B)

Sample Questions to ask yourself to assess your own Competency

How much do you know about systems theory?

Which specific systemic approach would you use?

What is your approach to helping couples and families communicate with one another?

How would you help a family whose pattern of interaction with each other is contributing to their presenting problem?

How would you work with a family who entered therapy to focus only on one individual’s behaviors (i.e., the scapegoat)?

Harway et al article would be good for you to read if you plan to pursue family counseling

Competency: Training & Supervision

Do not plan to practice:

How will you make sure you have proper training to consult with (and perhaps occasionally counsel) family members?

May Plan to Practice:

Where will you obtain additional training and professional development opportunities?

How will you seek out family counseling supervision as a new counselor?

Find a partner as discussed earlier and discuss how you will handle confidentiality/writing an informed consent through one of these two lenses.

Answer the questions in the box that fits your lens.

Personal Characteristics of the Family therapist

Self-knowledge is critical, especially family-of-origin issues

Take a minute to think about your own family of origin

What in your family history might cause you some vulnerabilities in your work with families?

Take a few minutes to reflect and write some notes on this.

You will not be asked to share these with anyone else.

Aside from seeking individual counseling, what else could you do in order to make sure that your family of origin issues don’t impact your work with Families?

Intimate Partner Violence

Intimate partner violence occurs in both same-sex and heterosexual relationships and affects people from all ethnic and socioeconomic backgrounds.

Under current law, mental health providers generally are not required to report intimate partner violence unless they meet certain criteria (see next slide)

For more information, visit:

https://www.acf.hhs.gov/sites/default/files/fysb/state_compendium.pdf

Florida does require LMHCs obtain DV training:

Intimate Partner Violence

The therapist’s goal is to protect victims from any further harm, including protecting any children the couple may have at home.

Recall mandatory reporting law regarding child abuse/neglect

Family Secrecy

Family secrets are often embarrassing and therefore hidden

however, these secrets can cause significant stress and problems in the everyday functioning of a family

Secrets are typically about topics that are uncomfortable to discuss including: Abuse (all forms), Violence, incest, biological parents (e.g., adoption), addiction, criminal activity, mental illness, and more…

Family Secrecy

Clients/students will divulge family secrets no matter what type of counseling you plan to practice

You may also have a hunch that a family secret might be Impacting a student/client

It’s important to recognize when family counseling is necessary

Family counseling can help families work through the embarrassment or shame caused by a family secret

Case Discussion

Luigi is a middle-aged parent who says that he is not seeking personal counseling but wants advice on how to manage his teenage daughter. According to Luigi, his daughter is immature and unruly. She isn't learning self-discipline, socializes too much, and works too little. She doesn't respect her parents or any other adults, and is a disappointment and a worry to him. In Luigi's eyes, the full responsibility for the conflict in his family rests with his daughter. You assume that he doesn't see any need to examine his own behavior or how the family may be involved in the problem.

What additional information would you want about the situation?

What ethical issues do you see in this case, and what do you base that assessment on?

Would you recommend family therapy and how would you present that to Luigi?

Would you accept Luigi as a client, even if he wanted to focus on how he could change his daughter? On what grounds would you accept him as a client?

Watch from 0-9:11