Family Therapy with Substance Abusers: Legal Considerations Regarding Confidentiality*

This paper explores various problems in the area of confidentiality often confronted by family therapists working with substance abusers. The scope and intent of the Federal Regulations controlling the release of all alcohol and drug abuse patient records and information are examined. Also, the rules regarding the release of confidential information by family therapists to attorneys, other family members and third-party funding sources are explained. Suggestions regarding the release of information in questionable cases are made. Finally, the growing use of family therapy in treating substance abusers, and its impact on confidentiality law and policy, is noted.     

Ethics and family therapy: the case management of family violence*

All family therapists, and especially Milan-style systemic therapists, have been trained to take a neutral stance regarding family issues, based on a circular causality model of family interaction. Therefore, when therapists deal with family violence, their ability to perceive individual responsibility for unethical behavior is weakened or suppressed. In fact, this ability is the primary tool in developing effective treatment planning in cases of family violence: The actively physically abusive man needs to be in individual and/or group therapy, not conjoint or family therapy. The ethical judgment of the therapist is what determines the limits of family therapy.     

ETHICAL DILEMMAS IN FAMILY THERAPY

A review of the literature in the area of ethical dilemmas facing family therapists revealed that there were a number of issues facing family therapists which are not included in the Principles for Family Therapists (1984) of the American Association for Marriage and Family Therapy. Seventy-five family therapists from across the nation responded to a questionnaire which asked what ethical dilemmas they face and how helpful the ethical guidelines are with these dilemmas. Results indicate that family therapists are encountering dilemmas which are not included in the Principles, significantly more often than those that are included. The ethical principles were found to be helpful for those ethical dilemmas attended to by the Principles.     

Public Participation: Moving Beyond the Four Walls of Therapy

Family therapists have an ethical responsibility for public participation, to work toward creating a better society. Serving the public interest and developing laws to promote the profession and the public good can be achieved through policy advocacy and political participation. Political and policy work are important but overlooked aspects of family therapy, which is significant given the consequences differing policies have for clients and the profession. This paper reports on results from a random, national survey of licensed family therapists’ (N = 174) advocacy actions. Findings indicate family therapists have overarching policy concerns yet lack proactive legislative and activist engagement. The exploration of therapists’ actions and beliefs presented in this paper, serves as a springboard for therapists’ movement into the public arena. Video abstract accessible by clicking here .     

Systems in Settings: The Therapist as Power Broker*

Family therapy discourse has given little recognition to either the specificities of the settings in which family therapy is employed or to the specificites of our clients. Clients are frequently constituted into the culturally subordinate position of ‘other’ to the therapist. This paper examines the ethical imperatives of the position therapists occupy in relation to their others.     

WHAT FAMILY THERAPISTS MIGHT LEARN FROM CHILD PSYCHIATRY

Recent articles in child psychiatry in America are reviewed, with emphasis on those studies ofinterest to family therapists. Major areas covered include: normal development, deviant development, and the impact of trauma. Differences from the "family therapy" literature include: multi-causal explanations, respect for scientific studies, reviews of progress in knowledge, and a deep-rooted ethical commitment to the welfare of children.     

A Brief Report on the Ethical and Legal Guides For Technology Use in Marriage and Family Therapy

Marriage and family therapists (MFTs) use ethical codes and state licensure laws/rules as guidelines for best clinical practice. It is important that professional codes reflect the potential exponential use of technology in therapy. However, current standards regarding technology use lack clarity. To explore this gap, a summative content analysis was conducted on state licensure laws/rules and professional ethical codes to find themes and subthemes among the many aspects of therapy in which technology can be utilized. Findings from the content analysis indicated that while there have been efforts by both state and professional organizations to incorporate guidance for technology use in therapy, a clear and comprehensive “roadmap” is still missing. Future scholarship is needed that develops clearer guidelines for therapists.     

Is Family Therapy Including Children?

This paper presents a review of recent child therapy and family therapy texts and training courses in Australia. The aim was to determine the extent to which knowledge and information about child development and emotional and psychological problems in children and adolescents is included in the education and training of family therapists. The paper argues this is crucial to prevent the difficulties of young person's being ignored or exacerbated and discusses relevant ethical issues.     

Protecting persons in family therapy research: an overview of ethical and regulatory standards

Family therapists are expected to engage in ethical and responsible research, while maintaining rigorous ethical standards and adhering to federal regulations that require protection for research participants. We present a short historical overview of the significant events and ethical controversies leading to the formulation of current regulations in human subject research and review. Federal regulations and guidelines, including issues of informed consent, special populations, and conflict of interest are reviewed. A short list of recommendations to assist family therapists in staying abreast of contemporary research protocol is provided.     

A perfect fit: connecting family therapy skills to family business needs

The purpose of this article is to encourage family therapists to become more interested in family business practice. It does so in three ways: (a) highlighting the number of therapists already involved in family business issues; (b) showing the parallels between family business and family therapy by applying family business research findings to couples therapy; (c) discussing how family therapists already have the practice wisdom to be effective in working with family business clients. Limitations of this practice are also discussed along with suggestions for overcoming them.     

Narrative Psychiatry and Family Therapy: Promoting Resilience and Collaboration with Persons with Intense Mental and Emotional Experiences at Risk of Causing Violence

Narrative psychiatry identifies meaning‐making as a primal force in our lives and guides family therapists and psychiatrists in cultivating narratives of resilience that support safety and wellbeing when working with families in which a member is dealing with intense mental and emotional experiences and may be at risk of causing violence. These contexts are fraught with implications about power, control, identity, and ethical responsibilities of care for those consulting with us and for the wider community. Offering benefits distinct from pathology‐focused psychiatric practice, narrative psychiatry applies the practices of narrative therapy in psychiatric contexts, focusing on strengths and meaning and honouring how values, intentions, and commitments compel and constrain our actions. Illustrated by case conversations, this paper describes five key practices of narrative psychiatry, including emotional attunement, understanding the person without the problem, externalising problems, creating narratives of resilience, and collaborative treatment planning. It shows how narrative psychiatry facilitates risk reduction through helping a person identify values and narratives that support non‐violence and strengthening abilities, relationships and resources that help them stay true to this commitment. Practical ways that family therapists and psychiatrists can use conversations about resources, including medicines, to deconstruct damaging discourses and generate narratives of resilience are described. Discussion is offered about how narrative psychiatry can support clinicians in ethically negotiating clinical dilemmas in which the preferences of the person or family are in conflict with the clinician's ethical and legal duty to protect life.     

HIV and family therapists' duty to warn: a legal and ethical analysis

In the absence of definitive legal precedents, family therapists must decide whether to warn sexual partners of HIV-positive clients when clients themselves refuse to do so. Deciding whether to break confidentiality reaises both legal and ethical issues. Legally, the Tarasoff ruling requires therapists to warn potential victims of illegal dangers posed by clients but does not require therapists to warn potential victims of dangers posed by their clients' legally permissible actions. unless the behavior of the seropositive client is proscribed by state law, warning the clients' partners does not fall within the scope of the Tarasoff ruling. Ethically, therapists must negotiate and adhere to a disclosure policy that balances considerations of respecting autonomy, maintaining integrity (avoiding fraud and betrayal), benefiting clients, and fostering responsibility. Some therapeutic and ethical aspects of these considerations are discussed.     

Considering justice: an exploratory study of family therapy with adolescents

Feminist approaches to therapy with adolescents emphasize an empowering focus on the strengths of adolescents while simultaneously insisting that therapists become aware of their own biases toward today's adolescents. However, a review of the family therapy literature finds little mention of feminist approaches for addressing injustices (e.g., family scapegoating, negative societal views of adolescents, and gender oppression) that arise in family therapy with adolescents. Therefore, this study explores clinical approaches and resources suggested by a surveyed group of self-identified feminist family therapists. In addition, we also recommend several approaches and resources that will aid family therapists in creating a more just climate for family therapy with youth.     

Children and psychotropic medication: a cautionary note

This report addresses how the mental health field is organized in terms of the use of psychotropic medications with children and adolescents, and the ethical challenge this presents to marriage and family therapists.     

Evaluation,Accountability and Clinical Expertise in Managed Mental Health Care

In this article, the author identifies a number of policies and practices of managed mental health care organizations that, if allowed to continue unchecked, will have deleterious effects upon the American family. Since this industry is not regulated by either state or federal statutes, managed care organizations have had free reign to disallow coverage for a variety of DSM-III-R diagnostic categories and V-Code conditions. Some organizations severely limit the number of collateral contacts their therapists can schedule with clients' family members and others prohibit their therapists from working with more than one family member at any given time. The author also highlights the complex relationship that exists among insurance companies, managed care organizations, the medical profession and the pharmaceutical industry. He then offers some hypotheses about the nature of these relationships and the reasons for their existence. Finally, the author calls for social work to take an active role in bringing these issues to public awareness and suggests that social workers become advocates for the American family in this era of managed care.     

“Being a Therapist Doesn't Exclude You From Real Life”: Family Therapists’ Beliefs and Barriers to Political Action

A crucial and overlooked facet of social justice in family therapy is political and policy advocacy. Family therapists have unique insight into how social policies and political discourse shapes clients’ lives and the life of our profession. Such knowledge can inform policymakers and political debate, yet few family therapists are trained to engage in political action. In this randomized, national survey of licensed family therapists’ (N = 174), we explore beliefs about and barriers to engagement in political and policy processes. The findings suggest that there are significant barriers and uncertainties surrounding family therapists’ engagement, including time, feelings of efficacy, and interest. Given these barriers we discuss practical suggestions for clinicians and family therapy training programs.     

Ethical dilemmas faced by family therapists

This study explores the reactions of 202 randomly selected clinical members of the American Association for Marriage and Family Therapy (AAMFT) to a variety of ethical dilemma situations which examine what family therapists are doing in their work when confronted with these difficult situations. Eight of the issues studied have been discussed in the literature and eight are included in the AAMFT's Ethical Principles for Family Therapists (1984). In addition to showing how clinical members responded to dilemmic vignettes that reflect these dilemmas, results indicated that family therapists are facing these dilemmas, have a high rate of consensus of what they would and would not do in each situation and almost all the situations were seen as being ethically significant by the majority of respondents.     

Integrating a Trauma Lens into a Family Therapy Framework: Ten Principles for Family Therapists

This paper aims to show how a trauma lens can be incorporated into existing family therapy practices, changing how therapists perceive presenting problems and therefore the issues and sites of intervention. After reviewing the family therapy literature concerning trauma and defining different types of trauma, the paper discusses how traumatic memories differ from ordinary memories. Ten principles for practice are described to guide therapists in integrating the trauma lens into their family therapy practice. Three case studies are used to illustrate these principles.