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.     

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.     

Dsm-iii-R and the family therapist: ethical considerations

DSM-III-R has gained popularity in many segments of the mental health field. Family therapists have generally not found its approach to assessing problems to be helpful in the planning of therapy, yet, are often forced to use it due to the requirements of third-party payers. This raises several ethical and practical concerns, e.g., the incompatibility of orientations between DSM-III-R and family therapy, the stigma associated with diagnosing, being asked to misrepresent diagnoses to third-party payers, and the competency of some family therapists to make DSM-III-R diagnoses. Short- and long-term strategies to deal with these ethical dilemmas are also presented.     

Navigating Dual Relationships in Rural Communities

The literature examining dual relationships in rural communities is limited, and existing ethical guidelines lack guidelines about how to navigate these complex relationships. This study uses grounded theory to explore rural therapists' perceptions of dual relationship issues, the perceived impact of minority and/or religious affiliation on the likelihood of dual relationships, and the ways rural therapists handle inevitable dual relationship situations. All of the therapists who participated in the study practiced in small communities and encountered dual relationship situations with regularity. The overarching theme that emerged from the data was that of using professional judgment in engaging in the relationship, despite the fact that impairment of professional judgment is the main objection to dual relationships. This overall theme contained three areas where participants felt they most needed to use their judgment: the level of benefit or detriment to the client, the context, and the nature of the dual relationship. Surprisingly, supervision and/or consultation were not mentioned by the participants as strategies for handling dual relationships. The results of this study are compared with established ethical decision‐making models, and implications for the ethical guidelines and appropriate ethical training are suggested.     

Opening Up: Therapist Self-Disclosure in Theory, Research, and Practice

While most therapists report that they do disclose some information about themselves to their clients, therapist self-disclosure continues to be both controversial and nebulous in clinical theory, research, and practice. This article considers what makes therapist self-disclosure so challenging to define and study and provides an overview of the empirical and theoretical literature. It then concludes with a consideration of therapist self-disclosure in contemporary legal, ethical, and technological contexts of clinical work.     

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 .     

Secondary Trauma: How Working with Trauma Survivors Affects Therapists

Secondary trauma, a relatively recent topic that has emerged in the field of social work, includes the emotional and psychological effects that working with traumatized clients has on therapists. Secondary trauma can seriously impact therapists' personal and professional well-being. Trauma therapists face major ethical dilemmas if their reactions to being traumatized enter into the therapeutic relationship, exposing clients to psychological harm or possibly re-traumatization. As many graduate programs in social work and social service agencies are still unaware of this phenomenon, recommendations are made for how to introduce the topic as priority and how to cope with and prevent secondary trauma.     

Reflexivity, Ethnography and the Professions (Complementary Medicine). Watching You Watching Me Watching You (and Writing About Both of Us)

That reflexivity is a characteristic of high modernity is now a truism, but its ethical and practical implications for field research have not been explored. The article is based on research conducted among complementary medical practitioners, focusing on issues of professionalisation. This research revealed the problematic and permeable nature of boundaries in ethnographic work. For example, in the course of interviews and observation therapists vouchsafed information to us which seemed controversial, even indiscreet. Was this a matter of their own naivety, their failure to demonstrate the mature ‘professionalism’ to which they aspired? Or was it a conscious strategy, conducted in the expectation that we would make such material public without attributing it to them by name? We were obliged to reflect on the nature of our own ‘professionalism’ as researchers, the ways in which private and public selves interact in the course of research. The confessional nature of some ethnographic writing raises further issues about trust, privacy and the preservation of professional boundaries between researcher and researched. We conclude that social scientists are entitled to critique ‘professionalism’ as a historically situated ‘folk’ concept whose rhetoric often obscures material interests, but they would do well not to abandon it themselves if they are to claim a responsible and ethical form of practice.     

FEMALE CAREGIVERS’ REFLECTIONS ON ETHICAL DECISION-MAKING: THE INTERSECTION OF DOMESTIC VIOLENCE AND ELDER CARE

As our population ages, increasing numbers of social workers and other therapists will provide counseling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.     

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.     

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.     

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.     

RESOLVING ETHICAL CONCERNS IN CLINICAL PRACTIVE: TOWARD A PRAGMATIC MODEL*

A pragmatic model is proposed for use in resolving ethical concerns and dilemmas in clinical practice. It encompasses five decision bases that therapists may draw on for the kind of comprehensive analysis that is necessary for reaching a defensible decision. The decision bases are: (a) theories of ethics; (b) professional codes of ethics; (c) professional theoretical premises; (d) the sociologal context; and (e) the personal/professional identity. The model is applied to five actual cases offered by several therapist who experienced ethical concerns with them. The case analyses demonstrate the model's utility for decision making and for prevention of ethical problems.     

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.     

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.     

Risks and wrongs in social science research. An evaluator's guide to the IRB

Having an Institutional Review Board (IRB) review and monitor the use of human subjects is now fundamental to ethical research. Yet social scientists appear increasingly frustrated with the process. This article aims to assist evaluators struggling to understand and work with IRBs. The author theorizes why IRBs frustrate and insists there is only one remedy: We must accept the legitimacy of IRB review and (a) learn more about IRB regulations, imperatives, and the new pressures on them; and (b) educate IRBs about social scientific methodologies and empirically demonstrable risks. A research agenda and tips are offered.     

Do current consent and confidentiality requirements impede or enhance research with children with learning disabilities?

Recent changes in UK legislation on data protection and confidentiality have affected key aspects of the research process. They have led to much stricter approaches to research governance, leading in turn to more stringent scrutiny by medical ethics committees and National Health Service (NHS) Trusts. Almost all stages of research are affected, from participant recruitment to storage of data, eating into researcher time and consuming significant resources. The resulting constraints are examined in relation to a research programme on development in children with learning disabilities, highlighting the practical and ethical issues arising, with informed consent a particular challenge. Being multidisciplinary, learning disability research has to satisfy numerous regulatory bodies. For participants' rights to be fully respected and for projects to be completed within time and on budget, all contributors to the research process, including funders, need to be aware of the additional implications and demands imposed by the new regulations.     

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.     

Relational Ethics and Moral Blindness: Startling Incongruities in Couple and Family Life

This article explores the common experience of working with couples and family members who describe their partners and children as important to them yet at the same time are cavalier, neglectful, ignorant, and even destructive in dealings with their loved ones. People who fail to relate ethically are said to be prone to have stagnant relationships, become corrupt in seeking solutions to moral problems, be more depressed, have poorer health problems, and experience lower quality relationships. This article describes ethical fading and moral blindness in couples and families and in our work as therapists. It argues a relational ethics frame that fosters ethical sensitivity and stronger moral identity both in ourselves and others is an important addition to our therapeutic repertoire.     

THE POLITICS OF GENDER IN FAMILY THERAPY

This article provides an overview of the political implications of various approaches to gender within the clinical literature. It emphasizes the process of the rapy within the social context of gender relations and identifies the politcal consequences of various clinical responses. Issues surrounding the appropriate role and stance of therapists relative to gender are identified, ethical issues such as neutrality and client welfare are re-examined, and suggestions for practice are addressed.