Mental health professionals take great satisfaction in their work as public servants, assisting people we serve so that they can contribute to society. American Association for Marriage and Family Therapy (2015) argues that marriage and family therapists are distinguished by an ongoing devotion to professional and ethical excellence. In addition, they can be distinguished in terms of commitment to service, advocacy, and public involvement in relation to. As mental health professionals devote themselves to people in this way, they must do it with the utmost respect, honesty, and compassion. Throughout their career, they often face a variety of situations in which they will have to make critical judgments that will have an impact on the therapeutic relationship, treatment, or process itself.
It is essential that a therapist follows the ethical, legal, and professional standards while making decisions. As a result, all certified marriage and family therapists are bound by state legislation and the ethical guidelines of the American Association for Marriage and Family Therapy (AAMFT) (Wilcoxon et al., 2021). The AAMFT Code of Ethics is a set of MFT ethical guidelines that guide the decision making process. Professionals should follow a set of criteria to make sure they are giving the best possible service to their customers. This is not just for the benefit of the client, but also for the benefit of the therapist. As long as the therapist’s principles and morals are not compromised, it can allow them to remain ethical.
Case Vignette
Your client is a 10-year-old adoptee who identifies as Chinese and male. His American mother referred the client following his disruptive behavior at school and home. The father also supports the mother’s decision to initiate therapy. You can establish a good rapport with the boy and work through his issues
Confidentiality and Privacy
Case Vignette: The mother informs you that a family physician who recently diagnosed her son with a sleeping disorder would like to know more about the boy’s therapeutic work and his success in therapy. The mother informs you that the physician will contact you shortly. In 2 days, you receive an email from the physician requesting information on the client.
Decision-making model concept
Confidentiality is critical in this line of work because it fosters an atmosphere of trust and privacy for clients and their therapists. The therapist is responsible for creating this environment for the client and enforcing confidentiality requirements to preserve the client’s information. Collaboration with other medical experts is a given in this field, as is the necessity of doing so on a regular basis (Wilcoxon et al., 2021). However, before any collaboration can begin, the therapist must first seek written consent from all persons involved. It is the policy of marriage and family therapists not to reveal client confidences unless the client gives written consent or waives their right to confidentiality (American Association for Marriage and Family Therapy, 2015). It will be required to obtain formal permission from both parents, even if the mother has already verbally agreed to the therapist and physician’s involvement in this case.
Decision made
When the client’s parent makes this request, I will explain that I am happy to comply since it will be beneficial to the patient’s recovery. First, I will get permission from the doctor to talk with him or her. Clients should know that their first interaction with the physician will be to determine what information is needed, how it will be communicated, and how long it will last. In order to provide my clients with the information they want, I would first meet with the doctor to acquire the data I need. As a follow-up, I will meet with the customer once more, this time laying out exactly what information I will be sharing with them, and for how long. I shall get formal consent to distribute the information from clients when they have been fully informed. If you want to communicate with your doctor online, you will need to ensure that systems can safeguard client information and employ encryption and password protection to transfer data securely.
Cultural Awareness & Sensitivity
Case Vignette: In session with the parents, the mother reveals that she does not allow her son to speak his native language at home. She is uncomfortable with him identifying with his culture because it disconnects her from him. She begins to talk about racially-biased behaviors from herself and her family with whom the son is in contact regularly.
Decision-making model concept
All aspects of our lives are affected by culture, thus culturally responsive practice must be a key part of what people do. Clients and therapists should keep in mind how culture shapes their perceptions of the world (Corey et al., 2019). It is important to keep in mind that the major customer is Chinese, and the parents are Americans. Since they have a different cultural background, there will be certain challenges that are directly related to this. The parent appears to exert considerable influence on the kid’s upbringing, given that the principal customer is a youngster. In this document, the family outlines the beliefs, principles, and traditions that they will adhere to. Mothers are afraid that allowing their children to speak their native language or identify as members of their own culture may lead them to lose touch with their children.
Decision made
Therapists must function as change agents as well as the obligation of value-sensitive treatment. My duty is to notice the problem and aid the customer in discovering new methods to deal with it then I do it, as well. Also, I have to consider their cultural values and be considerate to them. However, despite the fact that the primary client is a kid whose activities are strictly limited by his or her parents, it is still necessary for me to identify and explain the child’s culture since it has a direct impact on him. According to the AAMFT code of ethics, marriage and family therapists promote the welfare of families and people and make reasonable attempts to establish the right balance between opposing aims within the family system (American Association for Marriage and Family Therapy, 2015). This family’s cultural differences with the son are causing friction. It might jeopardize the progress and lead to more conflict if they ignore or disregard it. A compromise must be struck between their two cultures for me to help the family. The mother in this case narrative is at ease sharing the racial prejudice behaviors that she and her family exhibit. As the mother is able to open up to me about this, I need to look at where these sentiments and actions came from.
Mandated Reporting
Case vignette: One day, your client comes to the session and tells you that if he refuses to go to bed at a particular time, his father closes him in a bathroom for the rest of the night and does not give him anything to eat the following day.
Decision-making model concept
Reporting of child abuse and neglect is now mandatory by MFT and by law in the majority of states. The Department of Social Services in North Carolina requires me as a state citizen to disclose any concerns of child abuse or neglect to them and allow them to conduct their own investigation. There are penalties including jail time for failing to report, and you might also lose your license to practice medicine.
Decision made
Ultimately, I would report this to the Department of Social Services for my client’s case. Aside from informing my manager or director and consulting with legal counsel, I intend to report the incident in accordance with the company’s policy and practice. Treatment would have begun with a discussion about confidentiality. When I am a required reporter, I am not in charge of investigating or determining if the scenario is true or not. This is a sort of emotional abuse and neglect that can have long-term effects on the life of my client, despite its seeming innocence. I am not sure how long this has been a practice or how often it occurs as a kind of punishment. A simple remedy to this problem may be to get the father some aid and counseling on parenting skills, but if the problem persists, it may be necessary to remove my client from the home entirely. Both ways, as a therapist, I must keep my obligation to my client and preserve their well-being.
Multiple Relationships
Case vignette: One day, you conducted a family session: the boy, the mother, and the father are all present. After the session, you realize that the boy’s father was your parent’s lawyer.
Decision-making model concept
Dual partnerships are addressed in the AAMFT Code of Ethics section 1.3 on multiple relationships. It suggests that therapists should make every effort to avoid having numerous ties with their patients (American Association for Marriage and Family Therapy, 2015). Customers and their families should be included in the multiple relationship discussion. This guideline also takes into account the effect that therapists have on their clients, acknowledging that therapists may affect their clients’ thoughts and behaviors as agents of change. Therapy decisions should be made in a nonjudgmental and non-biased environment when the therapist’s judgment about the client’s treatment is clouded by many personal ties.
Decision made
Having learned that the therapistās father had previously served as the client parents’ lawyer, they should first consult with the supervisor or director. Marriage and family therapists should seek appropriate professional treatment for difficulties that may compromise job performance or clinical judgment (American Association for Marriage and Family Therapy, 2015). As far as I am aware, the client’s father is only connected to my parents in a professional capacity. In light of the conversation with my supervisor, I will consider whether or not I can continue therapy without bias or judgment. As soon as I have made a decision, I feel it is important to completely inform my clients of my decision. They need to be aware of our relationship even though I am confident I can provide the best service possible under these conditions. Ultimately, it determines whether or not to continue therapy with me. Ethics norm 1.8 Client Autonomy in Decision Making mandates that I accept any decision my clients make as long as they are properly informed when making any decisions regarding treatment.
Insurance and Non-Abandonment
Case vignette: Ten sessions into the therapy, your clientās mother informs you that their insurance panel did not approve further treatment
Decision-making model concept
Payments and Fees need to be covered during one-on-one and even pre-therapy intake processes. Therapy rates and payments must be clearly explained by the therapist. Patients must be informed of all expenses and financial obligations that the insurance company has, as well as their own duty should insurance no longer cover therapy costs, according to AAMFT code 8.2. Therapy may also be ended if the insurance company no longer covers treatments and the client cannot afford to pay. AAMFT code 1.11, which tackles the issue of desertion, does not allow therapy to cease suddenly. A therapist cannot “abandon or ignore clients in therapy without making adequate preparations for the continuation of treatment” under any circumstances (American Association for Marriage and Family Therapy, 2015). To continue with the therapy, there must be a strategy in place.
Decision made
A review and discussion of the financial policies will be necessary as soon as I am made aware of this circumstance. It is possible that this family might benefit from one of our payment plans. Consider, the case if the customer is unable to make the required payments, a free or low-cost resource may be used to continue treatments in this scenario. Therapy choices including group therapy at school or a local health facility, as well as relevant reading material, are examples of the required resources. This is a choice that the family will need some time to consider and debate. So that they may make an informed decision, I will provide them the time and resources they need. As a result of their decision, I would have to decide how to proceed with therapy.
Technology
Case vignette: A few months after termination of therapy, the father sends you a friend invite on social media with a message that he would like the family to update you on their progress.
Decision-making model concept
From staying in touch with friends and family across the country to never having to leave the convenience of your couch to go shopping, technology has played a major role in modern life. In many cases, people may get therapy from the comfort of their own homes because to the advancements in technology. As a result of technology’s effect, the AAMFT created standard VI, which addresses technology in treating clients (American Association for Marriage and Family Therapy, 2015). Access to technology has allowed clients and therapists to communicate instantly. However, technology has both positive and negative aspects. Clients’ access to the therapist’s private life has increased as a result of technological advancements. A therapist’s social media accounts may be easily searched for personal information (Reamer, 2017). It may have a devastating effect on the therapeutic relationship if it is not addressed. Electronic interaction or texting outside of regular sessions might sabotage the practitioner-client connection.
Decision made
Normally, I would not accept a friend request immediately away if it came my way. Even while I would love to be kept abreast of the family’s progress, this raises a moral question. I think it is a good idea to keep tabs on how our old clients are doing. To be fair, though, it may be unethical to do so and this may compromise my duties. Following the cessation of services, some jurisdictions impose a 2- to 5-year period of no contact with former clients; others do not officially ban contact but advise against it. Before making a decision, I would evaluate all of my options. For instance, I may evaluate the impacts of my accepting the invitation and outweigh with that of declining the invitation. Later, after a close analysis of the request, I will deem it fit to decline and inform the father to channel the family updates to the relevant offices.
Legal Considerations
Case vignette: One year after the termination of the therapy, you receive a subpoena from the mother’s lawyer asking you to be part of the court proceeding following the divorce of your client’s parents. The mother asks the court to end joint custody in favor of sole custody. The subpoena asks you to provide information concerning the divorce and child custody as addressed in the previous therapy and that you will be called to testify.
Decision-making model concept
Divorcing parents have a difficult decision when it comes to child custody. Marriage and Family Therapists have extensive training and experience in this field, making them great witnesses. The therapist can, however, be summoned to provide documents from treatment sessions after therapy has ended. It is important to note that a court subpoena is one of the exceptions to confidentiality rules. The AAMFT code of ethics has no precedence over family law. To comply with a court order, an MFT must present the requested documentation. I would notify my bosses and have legal counsel evaluate the documents as soon as I received a court subpoena. It is necessary to re-evaluate the subpoena to ensure that only the authorized individual receives the treatment that is indicated (Wilcoxon et al., 2021). In order to provide the requested records, both parents will need to sign a formal consent form.
Decision made
It was because the parents shared custody of the client at the time of therapy. Because of this, they must both sign off on the dissemination of the information. I will comply with the subpoena under the supervision of legal counsel, making certain that I get all forms of permission, safeguard client confidentiality, and only provide material when permitted. If the father’s lawyer suggests that his client not provide written consent, this is something to keep in mind.
References
American Association for Marriage and Family Therapy. (2015). AAMFT Code of Ethics. American Association for Marriage and Family Therapy, 45(7), 103ā108.
Cameron, S., & TurtleāSong, I. (2020). Learning to write case notes using the SOAP format. Journal of Counseling & Development, 80(3), 286-292. Web.
Corey, G., Corey, M. S., & Corey, C. (2019). Issues and ethics in the helping professions. Cengage Learning.
Reamer, F. G. (2017). Evolving ethical standards in the digital age. Australian Social Work, 70(2), 148-159. Web.
Wilcoxon, A., Remley Jr, T. P., & Gladding, S. T. (2021). Ethical, legal, and Professional Issues in the Practice of Marriage and Family Therapy. Pearson Higher Education.
Appendix A
SOAP Note Example
13/03/2022 2:30pm
S: The adoptee is a 10-year-old Chinese boy from a mixed-race family. Therapy has been started by the mother as a result of behavioral issues at home and in the classroom. There is currently no established timing for the beginning of behavioral changes. Client’s biological parents, who were married for five years before they adopted him, are both Americans. There are no known physical or mental health concerns that preclude participation.
O: The mother started the conversation by welcoming the client into the room. Slouched in the chair, a hood over his head, the client sat away from his parents. The fact that the client was required to attend treatment was causing her considerable distress. The client admitted to dragging his mother to the appointment since he did not want to be there. The client indicated dissatisfaction with both his educational setting and his family life. As soon as the hood was removed, the client’s eyes seemed black.
A: Due to parental pressure, the client has developed a strong resistance to therapy. A lack of sleep had left the client irritable and with black bags under his eyes at the beginning of our session. It is clear that the client is unhappy with his schooling and home situation, and he is especially angry with his mother.
P: The next meeting is planned for 2:30 p.m. on 12/04/22. The client’s reluctance to participate in treatment is slowing down progress. In the following session, the therapist will meet with each client one-on-one in order to develop a therapeutic connection by externalizing the client from the problem.
Appendix B
The Kitchener Decision Making Model Graphic
