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Ethical Concerns in Family Therapy
Abstract
Ethical issues for the family therapist can be complex when treatment of the family involves several members whose needs are conflicting. Such techniques as encouraging ventilation of hostile feelings, forming alliances with particular family members, and requiring reluctant members to attend sessions raise important ethical questions. The principle of confidentiality is less clear when the entire family is in treatment. Systematic ethics training should include examination of the therapist's own values and biases, as well as issues of honesty and competency, and continuing education programs. (24 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Other options for dealing with family secrets include the therapist announcing at the onset of therapy that he or she will not tolerate secrets (GAP, 1970;Hines & Hare-Mustin, 1978;Margolin, 1982), the therapist accepting confidences with an explicit agreement to work on a goal of sharing that information in a reasonable amount of time (GAP, 1970;Hines & Hare-Mustin, 1978;Okun & Rappaport, 1980), or the therapist having a general rule that individual confidentiality doesn't apply unless the client specifies what he or she does not want shared (Margolin, 1982). ...
... Other options for dealing with family secrets include the therapist announcing at the onset of therapy that he or she will not tolerate secrets (GAP, 1970;Hines & Hare-Mustin, 1978;Margolin, 1982), the therapist accepting confidences with an explicit agreement to work on a goal of sharing that information in a reasonable amount of time (GAP, 1970;Hines & Hare-Mustin, 1978;Okun & Rappaport, 1980), or the therapist having a general rule that individual confidentiality doesn't apply unless the client specifies what he or she does not want shared (Margolin, 1982). ...
... Various professional organizations stress the importance of confidentiality in the counseling relationship, but these rights are not always guaranteed by the legal system. Professional guidelines are basically useless in protecting the professional from civil or criminal action (Hines & Hare-Mustin, 1978). A person with a doctoral degree in psychology or psychiatry has a better chance of being covered by a state privilege status than someone with a less traditional degree. ...
Explores the place of assessment and interventions with families in terms of the psychologist's role and school policy. As school psychologists increase family involvement, there is a need to examine potential ethical issues. Ethical concerns related to school psychologists working with families are considered in relation to the
American Psychological Association Ethical Principles of Psychologists (1981). Topics discussed include responsibility and welfare of the consumer, competence, confidentiality, intrafamilial issues, extrafamilial or privileged information, research with human participants, and stereotypes and values. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The relative valuing of certain therapeutic outcomes is also related to the choice of an individual or systemic modality in family therapy (Sider & Clements, 1982). A frequent ethical dilemma centers on who the therapist is ethically bound to serve (Hines & Hare-Mustin, 1978;Morrison, Layton, & Newman, 1982;Sider & Clements, 1982). Martin (1980, as cited in Sider, 1986 showed that the primary goal of marital therapists has changed considerably in the last 25 years from simply maintaining marital units to maximizing individual fulfillment within mutually satisfying marriages. ...
... Individuals may have to subordinate their own needs and goals if priority is given to the good of the family as a whole. An individual may also have to give up limited confidentiality and privacy when participating in therapy aimed at improving the functioning of the family unit (Hare-Mustin, 1980;Hines & Hare-Mustin, 1978). ...
... There are several policies that the therapist may adopt regarding secrets that may be revealed in therapy. First, the therapist may decide that no secrets will be kept in therapy (Hines & Hare-Mustin, 1978). Secondly, the therapist may treat each family member's confidences as though that person were an individual client; therefore, no private information is divulged to other family members (Margolin, 1982). ...
Reviews the literature regarding ethical issues frequently encountered in marital and family therapy. Ways to engage nonattenders, maintain confidentiality, and successfully terminate therapy are also discussed. Possible ways to expand existing ethical guidelines are suggested. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The therapeutic techniques most often cited as unethical by critics of family therapy are: paradox, the ''benevolent lie,'' reframes, and other techniques that are considered manipulation and are most often associated with strategic therapy (DiNicola, 1988;Doherty, 1985;Hare-Mustin, 1980;Hines & Hare-Mustin, 1978;Lindley, 1987;Solovey & Duncan, 1992;Wendorf & Wendorf, 1985). Existing ethical models used by mental health professional organizations focus on individual rights, a perspective associated with Cartesian dualism and traditional individual psychology (Becvar & Becvar, 1996). ...
... When ethical decisions, evolving from systems/cybernetics theories, are evaluated from the traditional epistemology of Cartesian dualism, they may appear to be lacking respect for the rights of the individual family members. This problem is illustrated in the classic criticisms of family therapy presented by Hare-Mustin (Hare-Mustin, 1980;Hare-Mustin, Marecek, Kaplan, & Liss-Levinson, 1979;Hines & Hare-Mustin, 1978). Hare-Mustin and her colleagues express concern for the individual in family therapy and support the need to endorse self-determination and independence from the family. ...
... The family therapist group included only those persons who identified themselves as family therapists, and who used the theoretical perspective of family systems theory/ cybernetics and/or had specialized graduate or institute education in family therapy. Because the therapeutic techniques most often seen as unethical by critics of family therapy are associated with strategic therapy (DiNicola, 1988;Doherty, 1985;Hare-Mustin, 1980;Hines & Hare-Mustin, 1978;Lindley, 1987;Solovey & Duncan, 1992;Wendorf & Wen-dorf, 1985), informants placed in this group also identified themselves as using the techniques identified with strategic therapy. Individual therapists were persons who identified themselves as such, and reported not using theoretical orientations related to systems/cybernetic theory or the therapeutic techniques identified with strategic therapy, and also as not having advanced education in family therapy. ...
In this study, we investigated the ethical decision making of 30 individual and 30 family therapists in order to detect the types of decision making used by practicing therapists. Informants responded to three ethical dilemmas. Two of the situations were hypothetical. The third dilemma was a situation the informant had experienced in practice. Each interview was assessed for decision-making style, using content analysis. Kohlberg's justice reasoning and Gilligan's care reasoning provided the conceptual foundations for this analysis. The results suggest that both family and individual therapists prefer care reasoning on all dilemma types. There was significantly more care reasoning demonstrated on the personal dilemma than on the hypothetical dilemmas. Characteristics of informants did not provide clear explanations for the differences found in reasoning.
... Confidentiality in the family system is a somewhat different matter, due to the differences in status and maturity between parents and children. First, it is the family therapist's clinical responsibility to insure the couple's confidentiality with respect to the children (Hines & Hare-Mustin, 1978;Minuchin, 1974). Couples who have difficulty setting boundaries around their relationship, as separate from the children, need to be guided (1) to establish privacy in the marriage and (2) to avoid burdening the children with information that is frightening, provocative, or simply beyond their comprehension. ...
... To what extent does the therapist accept the family's definition of sex role identities as opposed to attempting to influence and modify their attitudes in this regard? Recent attention to this question has led to the conclusion that marital and family therapy often tends to reinforce sex role stereotyping (Gurman & Klein, 1981;Hare-Mustin, 1978). Of the sexist attitudes found to characterize psychotherapy in general (APA Task Force on Sex Bias and Sex-Role Stereotyping, 1975), family therapists are particularly vulnerable to the following biases: (1) assuming that remaining in a marriage would result in better adjustment for a woman; ...
... By attempting to remain nonjudgmental about the client's objectives, the therapist may unwittingly reinforce these sexist attitudes. But by attempting to reorient them to an egalitarian viewpoint, the therapist might thwart the family from attaining their goals and alienate those individuals whose socialization is such that they are happy with traditional roles (Hare-Mustin, 1978). Consider, for example, the following disagreement over management of a household. ...
Notes insufficiencies in the American Psychological Association’s ethical standards for marriage and family therapy. Guidelines regarding therapist responsibility, confidentiality, and informed consent sometimes become ambiguous with individual clients, but they are even more complicated when multiple family members are seen together in therapy. Questions about confidentiality, refusal of treatment, and value of conflicts between the family members and the therapist may arise. Consideration of these questions in terms of their ethical implications is complex and controversial. Yet answers to these questions must also take into account clinical and legal considerations, which sometimes run a collision course with what is desirable from a strictly ethical standpoint. Examples and preliminary recommendations with respect to these issues are examined; further clarification of professional conduct in marital and family therapy is urged. (45 ref)
... Casualty status has been associated with clients who hold unrealistic expectations for groups (American Psychological Association, 1973;Lieberman, Yalom, & Miles, 1973). In family and marital therapy, various participants may have conflicting goals (Hines & Hare-Mustin, 1978). Therapists must be cautious about supporting goals for the maintenance of the family unit that override the rights of individuals. ...
Discusses ways in which ethical principles can be put into practice in the client–therapist relationship. Historically, ethical codes for therapists were drawn up to protect the professions from regulation by external agencies. Implicit in the ethical codes, however, is a model for the client–therapist relationship that fosters the goals of mental health. It is suggested that just as ethical codes have been given specific content in standards for providers of psychological services in human service facilities, ethical codes can be given specific content in the client–therapist relationship. It is recommended that therapists take responsibility for incorporating ethical standards into their practices so that clients' rights will be an integral part of therapy. Four illustrative situations are presented: providing clients with information to make informed decisions about therapy, using contracts in therapy, responding to clients' challenges to therapists' competence, and handling clients' complaints. (63 ref)
... An Indian family regards the priority of welfare on the basis of several criteria-either the one who is senior most in the family or is the breadwinner in the familyit is rare to find and equitable status quo for the same. The challenge doubles in such a situation [5]. ...
... Over the past 40 years or so, numerous articles and book chapters have been published that have considered a range of ethical issues, in couple and family therapy, that have highlighted the complexity of such matters as confidentiality (or multiconfidentiality), keeping secrets, therapist's values, professional competency, dual relationships, informed consent, use of the DSM, and withholding services from families and non-attending members (e.g., Hines & Hare-Mustin, 1978;Margolin, 1982;Negash & Hecker, 2010;Shaw, 2011a;Walrond-Skinner & Watson, 1987;Zygmond & Boorhem, 1989). It is not possible to consider all the issues in this column, but I have decided to raise some of the main points in relation to: (1) informed consent; (2) confidentiality; and (3) use of the DSM, in order to illustrate some of the ethical complexities family therapists may face. ...
... Many therapists espouse the view that the welfare of an individual client depends on the family being involved in treatment (Grosser & Paul, 1964). However, they do not seem to have given attention to the ethical issue involved in requiring all family members to participate (Hines & Hare-Mustin, 1978). Some family members may have successfully disengaged themselves from an "enmeshed" family (Minuchin, 1974), so requiring them to become involved again is not in their best interests. ...
Suggests that family therapy as a treatment approach that requires the involvement of the entire family may not be in the best interests of individual family members. The priority given to the good of the family as a whole leads to risks for individuals. By being required to participate in therapy, individuals may have to subordinate their own goals and give up limited confidentiality and privacy. The acceptance of the traditional family as the ideal family model may foster stereotyped roles that disadvantage individuals and limit their well-being. (12 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Conjoint therapy can enable clients to change in a way which is not at their own or someone else's expense -particularly someone else with whom the client is involved in an important reciprocal role relationship (Fox, 1968). If the improvement of the client seen in therapy is of foremost concern, and is seen as inextricably linked to the interpersonal situation, the clinician must be aware of how changes in the client will effect the other family members, and can be guided by such information by involving the family in treatment (Fox, 1968;Grosser & Paul, 1964;Hines & Hare-Mustin, 1978). With regard to the situation concerning a marital couple, the appropriate theoretical model views the spouse as importantly involved in the maintainance, expression and modification of any problems or complaints which the client brings to the therapist. ...
A brief review of the literature establishes the high potential for disturbance of a client's marital relationship following individual psychotherapy. Several problems possibly inherent in the conduct of therapy with only one member of a marital dyad are discussed, as well as some of their probable sources. The importance of informed consent to treatment is stressed with regard to ensuring that potential clients are aware of the possible negative effects of therapy on their marital relationship. The systemic view of the spouse as necessarily involved in the maintenance and modification of the client's complaints, provides an alternative to individual psychotherapy: The spouse must be a part of their therapy from the beginning. It is suggested that the ethical responsibility of the therapist is toward the greatest overall benefit for the client and should concern the interpersonal as well as the psychological environments of the clients they serve. (French abstract) (28 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Engaging in values clarification, generally, and specifically with regard to the socializing influences regarding men and masculinity, was highly valued by both female and male panelists. Such a perspective is in keeping with the feminist critique of family therapy (Feldman, 1982;Goldner, 1988;Hare-Mustin, 1978Hines and Hare-Mustin, 1978;Jacobson, 1983;James, 1984;James andMcIntyre, 1983, 1989;Taggart, 1985), and is in keeping with the recommendations of Erickson (1998) and others (McDaniel et al., 1995). Seventy per cent of the original items in this category were endorsed as significant by both female and male panelists, suggesting the paramount importance of the therapist uncovering the subtleties of his or her own gender socialization in developing the basic awareness of gender issues. ...
The results of this exploratory Delphi study provide a beginning formulation of a gender-sensitive approach to working with men in the specialized field of couple and family therapy. The research specifically investigated what a panel of thirty-six ‘expert’ family therapists believed would be appropriate and effective techniques to engage men in therapy and in the process of family change. This report focuses on findings highlighting differences between what female and male therapists preferred as techniques to work with men in family therapy.
... Many articles have been written in recent years about the role of ethics in marriage and family therapy (2,6,8,10,16,18,20,22). These articles have examined such issues as confidentiality, privileged communication, family secrets, use of paradoxical techniques, and the role of therapists' values within the treatment context. ...
In family therapy, effective clinical decisions promote the welfare and interests of the family and its individual members. However, the needs of the family and its individual members are often in conflict. Resolving this conflict is an ethical as well as a therapeutic dilemma. Kitchener has developed a model of ethical decision making that we have found useful in teaching students and supervisees how to resolve conflicts between the family's needs and the needs of its members. The purpose of this article is to discuss this model and show how it can be applied to clinical decision making.
... However, the literature on ethical problems in psychology indicated that there were psychologists who believed that the ethics code did not support them enough (e.g., Eberlein, 1980;Hallenstein, 1978;Hines & Hare-Mustin, 1978;Perlman, 1977). They were often those working in fields that have only recently evolved (for example, community psychology or family therapy), or who were involved in issues about which there has been a recent raising of consciousness in society (for example, women's issues or children's rights). ...
Over the past five years, the Canadian Psychological Association has been in the process of developing a new code of ethics for Canadian psychologists. Reasons for this effort are outlined, and the previously used American Psychological Association code is examined from the point of view of four main purposes of ethics codes: to help establish a group as a profession; to act as a support and guide to individual professionals; to help meet the responsibilities of being a profession; and to provide a statement of moral principle that helps the individual professional resolve ethical dilemmas. The objectives, methodology, and an outline of the new Canadian code are presented.
This comprehensive and highly readable book outlines the main psychological therapies used in contemporary clinical practice. It clearly describes the underlying theoretical principles and techniques and with vivid case examples, demonstrates the central role of these treatments in mental health care. The contribution of psychological and psychodynamic ideas to different psychiatric presentations is outlined, including mood disorders, psychosis, self harm and suicide. Other chapters specifically address recent developments, including neuropsychoanalysis, psychedelic-assisted psychotherapy and Open Dialogue. As the chapters unfold this book illustrates how a psychologically informed approach to mental disorder can enrich psychiatric practice by providing a holistic and meaningful understanding of the symptoms of psychological distress. Bringing together ideas from psychiatry and psychotherapy, this is the go-to text for trainees, experienced psychiatrists, and other mental health professionals interested in the psychological and psychodynamic aspects of psychiatry. An essential resource for preparation for the MRCPsych examinations.
With the recent observation by Weisz and his colleagues that efficacious research-based child psychotherapies are not translating to effective community-based practices (Weisz, Donenberg, Han, & Kauneckis, 1995a; Weisz, Donenberg, Han, & Weiss, 1995b; Weisz & Weiss, 1993, the importance of building capacity to conduct rigorous outcome research in community settings has become a priority (e.g., Hoagwood, 1997; Hoagwood, Hibbs, Brent, & Jensen, 1995. The primary purpose of this chapter therefore is to describe strategies that have been successfully used to conduct controlled outcome studies in real-world settings: community mental health centers, private provider entities, and several state agencies. Experiences in conducting clinical trials with multisystemic therapy (MST) (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) provides an example of how the rigors of laboratory-based treatment research can be translated into the pragmatics of community-based outcome research or clinical services research (Henggeler, Schoenwald, & Pickrel, 1995; Schoenwald & Henggeler, in press).
The application of creative techniques in counseling is often tailored to a unique problem, and limited by individual characteristics of the client. One intervention, sandtray therapy, a derivative of play therapy, has gained strong momentum as a creative technique. With greater flexibility for treating a much larger population, sandtray therapy is more applicable for families than other creative approaches. The purpose of the current article is to give an overview of sand tray therapy, as well as provide information regarding its use for working with families. Specifically, the authors discuss exactly how counselors can successfully incorporate sandtray therapy in the familial population setting, and describe its application through case study.
While many advances have taken place in the areas of family life education and marriage and family enrichment, less discussion has developed concerning ethical issues in the field. In this paper, a summary of ethical issues are presented that have been identified previously in education and enrichment. In addition, concerns in the area of marriage and family therapy are applied to the interventions of education and enrichment. Finally, a number of modifications are suggested and some ideas for a specific code of ethics are described. It is hoped that such a summary and list of suggestions will encourage further discussion and development among family professionals, training and intervention programs.
The author outlines the role and responsibilities of the Human Rights and Equal Opportunity Commission, then considers the ethics and responsibilities of the family therapist, with particular reference to the Rights of children.
In this article, significant ethical issues that arise in the conduct of family therapy research are considered and four major areas are emphasized: (a) the researcher's responsibility to protect the rights of research participants, (b) confidentiality and informed consent, (c) the researcher's values, and (d) methodology. In each area, parallels are drawn between the ethical issues facing family clinicians and those facing family researchers.
Counseling practitioners are increasingly being exposed to the theoretical ideas and clinical techniques based in systems thinking. Systemic or interactional counseling approaches are based on an alternative view of causality and symptomatic behavior. As a result, several treatment, ethical, and legal challenges await the counselor who attempts to implement these theoretical ideas. Because of these potential problems, practitioners interested in such approaches must recognize and be prepared to deal with the unique diffculties that accompany this method of counseling. Using spouse abuse as an example, the author reviews the basic components of systemic approaches, identifies the potential problems inherent in their implementation, and offers solutions for the interactional counselor.
In spite of feminist analyses of domestic violence that emphasize the social roots of battering, interventions with batterers are primarily conceptualized within the framework of the private sychotherapeutic encounter. Furthermore, it is still often women- be they battered women's advocates, shelter workers, or feminist clinicians-who hold batterers accountable for their violence. This article presents an alternative framework that suggests links between domestic violence and the social values of the privacy and autonomy of the family, as well as with male rites of passage organized around themes of violence or the devaluation of women. From this frame of reference, a central component to ending violence against women entails men holding men accountable for battering. The development of a community based male sponsor program that functions in conjunction with more conventional psychotherapy of batterers is described.
This article examines the manifestation of addictive family system dynamics in a parallel process among the addiction treatment staff system. Suggestions for utilizing ethical principles and guidelines to erect appropriate staff system boundaries are given. Ethical principles and guidelines, training, and open staff discussion are presented as resources available to aid in the maintenance of healthy staff system functioning.
Historically, general systems theory has been one of the conceptual foundations for family therapy. However, there are indications that systems theory, originally developed for nonhuman systems, may have significant limitations in accounting for family dysfunction and for guiding intervention. Clinically, systems concepts have been applied in a “one-size-fits-all” manner to families, with little attention to which intervention approaches are optimal for specific families. Ethically, systems therapy presents significant dilemmas in a society that reveres individual rights and well-being. These challenges to the family therapy field are discussed within the context of William Perry's model of intellectual and ethical development.
Ethical and legal issues concerning the application of informed consent in psychotherapy are reviewed in relation to: 1) controversies in defining an informed consent; 2) ethical and legal responsibilities of a psychotherapist in obtaining an informed consent; 3) potential ethical and legal liabilities for not implementing the informed consent doctrine; and 4) principles of confidentiality and privileged communication as they apply to this doctrine. Suggestions are made on how to implement an informed consent legally and ethically in psychotherapy.
Family-of-origin work is defined as a person's attempt to examine and/or change the patterns of interaction that occur in the family in which s/he was raised. This article outlines a model of family-of-origin work that is used in the clinical psychology training program at St. Louis University. The family therapy literature, particularly the work of Bowen, provides its theoretical underpinnings. An integral part of family-of-origin presentations is the genogram, or visual depiction of a family tree. Many ethical issues arise from the use of family-of-origin work within the context of clinical training, including confidentiality, responsibility, informed consent, values, and the boundaries of the supervisory relationship.
There is a growing number of unlicensed poorly trained lay practitioners conducting individual and group hypnosis for a variety of psychological and medical problems. Few states have restrictive legislation or regulations and most often anyone can offer hypnosis without any required education, training or experience. The potential risk to the mental health of the public and possible preventive actions are described.
The AAMFT Commission on Accreditation (COA) requires that a course in ethics/professionalism be taught to therapists in training. Results of a study that analyzed syllabi from the ethics courses of accredited MFT training programs across the United States are reported. Accredited programs are making an effort to teach about ethical dilemmas, legalities, and professional issues in MFT. These are the three specific areas AAMFT requires programs to teach. Other important topics are also being presented in this course. These topics were not consistent from syllabus to syllabus and may more accurately reflect the professor's world view than requirements set by the COA.
Identifies major didactic and experiential components essential to sound training programs in marriage and family counseling and therapy. These include the examination of various family systems theories, an understanding of family-of-origin issues, the use of live supervision and direct feedback, and exposure to unique ethical problems when working with married clients. Today, constructivism, feminist family therapy, diversity, and research present penetrating challenges to these training paradigms, affecting both the methods used and areas emphasized in preparing counselors and therapists to assume their professional roles. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the historical context for the rising interest in values and ethical issues in family therapy. A framework is presented for analyzing the core values of the prominent models of family therapy, based on the fundamental interpersonal orientation dimensions of control, inclusion, and intimacy. The ethical debate over the use of paradoxical techniques in family therapy is used as an illustration of a clash in values between different models of family therapy. (16 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This bibliography compiles references from 1970 to 1982 on ethical and legal issues in various areas of therapeutic practice. The 162 references are intended to provide resources to the practitioner that are easily accessible in the published literature. Works deal with child therapy, marital and family therapy, group therapy, behavior therapy, community work, forensic work, and testing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents several scenarios that illustrate the ethical and practical issues involved in conducting family therapy research. The 3 elements of informed consent, identified in the Belmont Report (1979) as information, comprehension, and voluntariness, are discussed. Guidelines for applying the American Psychological Association ethical principles (see record
1982-04246-001) from a systems-sensitive perspective are offered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The results of this exploratory research provide a beginning formulation of a gender-sensitive approach to working with men in family therapy. A panel of 36 family therapists endorsed 131 interventions as appropriate and effective ways to work with men. The results suggest the importance of therapist awareness of gender issues and socialization in working with male clients. Interventions were highly endorsed in the areas of developing therapist perceptual and conceptual skills regarding gender, promoting mutual responsibility, and challenging stereo-typical behaviors and attitudes. Surprisingly few interventions pertaining to structuring treatment and encouraging affective expression in men had sufficient consensus to be included in the final results.
Family therapy's neglect of social context as a factor in its continuing distortion of women's issues has led feminist critics to wonder if systems-based psychotherapy truly serves women. Rather than heralding the demise of family therapy, however, the feminist critique is here taken to open up concerns central to the epistemological discussion underway in the field. At first, these have to do with the functions of “punctuation,”“boundary” and “closure” in systemic epistemology. Later, the central question becomes that of the place given to context in systems epistemology generally, as well as family therapy in particular. Several implications of a more lively interest in context for family therapy's work are explored. These are discussed with respect to women's issues, clinical epistemology, and the challenge to raise novel questions 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.
This paper reports a study of 63 initial interviews of structural-strategic therapy with families with child-focused problems. These interviews were analyzed to determine differences in the process of therapy between male and female therapists. We tested specifically for differences in joining and executive skills between male and female therapists. Transcripts made from audiotapes of the interviews were coded with the Therapeutic Interaction Coding System (TICS). Thirtyseven cases completed therapy, and 26 dropped out of therapy against therapists' advice. There were no significant differences in male and female therapists' case completion rates. The overall level of supportive statements was not significantly different between males and females. Family members made more structuring or directive statements toward male therapists, but stated more disagreement with other family members when their therapist was female. Male therapists made more explanation statements than female therapists in response to family members' structuring or disagreement statements. In addition, we tested for differences in activity level and found that male therapists made more statements overall than did female therapists.
A critical review of the literature on family therapy ethics is used to develop the proposition that a more systemic analysis is needed, one that includes the levels of therapist and society as well as patient (family). These ideas are discussed through reexamining the issues of family secrets, therapist deceptiveness, and therapist advocacy of personal (feminist) values.
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.
This chapter describes contributions from the field of marriage and family therapy to theory about the family. It is intended
for readers who have little familiarity with family therapy and emphasizes theories about how families function rather than
how families change in therapy.
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'sEthical 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.
Although family therapy recognizes the importance of the social context as a determiner of behavior, family therapists have not examined the consequences of traditional socialization practices that primarily disadvantage women. The unquestioned reinforcement of stereotyped sex roles takes place in much of family therapy. A feminist therapy orientation that considers the consequences of stereotyped sex roles and the statuses prescribed by society for females and males should be part of family therapy practice. This paper describes the ways in which family therapists who are aware of their own biases and those of the family can change sexist patterns through applying feminist principles to such areas as the contract, shifting tasks in the family, communication, generational boundaries, relabeling deviance, modeling, and therapeutic alliances.
Misconceptions concerning the existence and scope of the legal privilege for communications in therapy are considered. Basic limitations on the protection afforded by the privilege are treated, as are some major specific exceptions and waivers, particularly as they raise special difficulties for the therapist who works with groups, couples and families. Practical suggestions for the therapist and directions for policymaking by the helping professions are presented.
After briefly describing the need for ethics in the development of professional regulation and analyzing the historical emergence of codes of ethics, the goal of this paper is to scrutinize the process by which the American Psychological Association developed its own Code of Ethics and proceeded to revise it periodically. Different lessons can be derived from these efforts and from the criticisms that were formulated. The need for international standards in professional and research ethics is then considered, and the results of a recent study on this subject are presented. Five major conclusions can be derived from the preceding analysis: (1) Codes of ethics can help professional recognition by stressing the importance given to the protection of the public, (2) the development of a code of ethics is usually related to the advancement of professional practice, (3) ethical standards should be in tune with the cultural values and the belief system of a given community, (4) a well-balanced code should incorporate both general aspirational principles and enforceable standards, and (5) the method used to define principles and standards should be empirically based.
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