Couple/Family Work Keith A. Cross, Ph.D., LMFT July 28, 2017 - - PowerPoint PPT Presentation
Ethical, Legal and Relational Risks of Integrating Individual and Couple/Family Work Keith A. Cross, Ph.D., LMFT July 28, 2017 Objectives Participants will be able to identify the ethical risks of combining individual and couple/family
Participants will be able to identify the
Participants will know the specific State of
Participants will be able to identify the
What we will skip: Clinical effectiveness
Introductions Key Definitions
Clients vs Consultants Informed Consent Treatment Confidentiality
Ethical, Legal, and Relational Dilemmas Case Studies Recommendations Conclusion
Name What is your professional
Under what ethics code do you
In what setting do you practice?
Client/Identified patient Couple/Family
Need to clarify if there is an IP or if the
“system”/couple is the client
Consultant/Collateral Contact
The right of the clients to be informed about their
therapy and to make autonomous decisions pertaining to it. It is a shared decision-making process in which a practitioner provides adequate information so that a potential client can make an informed decision about participating in the professional relationship. It is both an ethical and legal obligation of the clinician to provide information to clients before they participate in assessment or treatment (CCC&C, 2014).
Marriage and family therapists obtain appropriate
informed consent to therapy or related procedures (AAMFT Code of Ethics, 2015)
When psychologists… provide assessment, therapy, counseling
transmission…they obtain informed consent of the individual
Code of Conduct, 2010)
Clients have the freedom to choose whether to enter into or
remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both counselors and clients. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship. (ACA Code of Ethics, 2014)
Informed consent for treatment is “a written document”
which must be “dated and signed…before providing treatment to the client AND when a change occurs in” an element in the informed consent… “that might affect the client’s consent for treatment.” (AZBBHE)
a. “Purpose of treatment”
What might constitute a change in the “purpose of treatment”?
b. “General procedures to be used in treatment, including
benefits, limitations, and potential risks”
What might constitute a change in the “general procedures to
be used”?
c. “The client’s right to have the client’s records and all
information regarding the client kept confidential and an explanation of the limitations on confidentiality”
What might constitute a change in the these “client’s rights”?
Heitler (2001) quote There is also a “middle-ground” approach that argues that
counselors should make the decision to accept and hold confidential secrets in accordance with the greatest benefit for the couple and the therapeutic process (Remley & Herlihy, 2005).
Bass & Quimbly, 2006 – Maintain secrets on a case by case
basis.
“The least risky intervention may not always be the most
therapeutic.”
Sample “Informed Consent Document For Individuals In Couples
Counseling”
Margolin (1982) stated, “The most difficult predicament for
the therapist would be if she or he failed to convey a policy
IAMFC, Ethical Code, 2011) – “Couple and family counselors
inform clients that statements made by a family member to the counselor during an individual counseling, consultation,
Such statements are not disclosed to other family members without the individual’s permission. However, the couple and family counselor should clearly identify the client of counseling, which may be the couple or family system, and inform clients in writing who(m) the identified client is. Couple and family counselors should inform clients that they do not maintain family secrets, collude with some family members against others, or otherwise contribute to dysfunctional family system dynamics. If a client’s refusal to share information from individual contacts interferes with the agreed goals of counseling, the counselor may terminate treatment and refer the client to another counselor.”
ACA, AAMFT
, APA do not address this issue
ACA Code of Ethics (2014): In couples and family counseling,
counselors clearly define who is considered “the client” and discuss expectations and limitations of confidentiality. Counselors seek agreement and document in writing such agreement among all involved parties regarding the confidentiality of information. In the absence of an agreement to the contrary, the couple or family is considered to be the client.
Richard Lesley Avoiding Liability Bulletin on No Secrets Policy PRC Policy in Disclosure Statement: “Couples seen as clients
maintain that the therapeutic process requires that information shared individually with the client may not remain confidential from the other partner, as the therapeutic process requires open communication between both partners in the safe environment.”
“The application by a licensee of one or
more therapeutic practice methods to improve, eliminate, or manage a client’s behavioral health issue.” (AZBBHE)
At what point does one become a “client”
(and therefore need signed informed consent?)
DTO/DTS
Is the clinician competent to treat
What does the AZBBHE, Psych Board, and
Codes of Ethics tell us about this issue?
Scope of Practice (both licensure laws and ethics
codes)
How does the clinician manage information
from the original counseling relationship in sessions with the new relationship?
Is the information from individual sessions acceptable
to discuss in couple/family sessions or is it kept “secret”/confidential)?
Can the clinician remember what information was
disclosed in 1:1 sessions and not in couple/family sessions?
Can the client remember what information was
disclosed in 1:1 sessions and not in couple/family sessions?
What (if any) are the legal implications of
unintentionally disclosing a secret?
What does the AZBBHE, Psych Board, and Codes of
Ethics tell us about this issue?
How does the clinician maintain the client’s (or
clients’) records?
If the clinician is conducting ongoing individual
counseling concurrently with couple/family counseling, does the clinician maintain one file or separate the cases?
What if the individual or couple/family work is short
term (i.e. 3-5 sessions)?
What if the couple breaks up/divorces and the clinician
continues to see one of the individuals?
If one file is maintained, and there is a request for
information, what is released (and what is not)?
What does the AZBBHE, Psych Board, and Codes of
Ethics tell us about this issue?
AZBBHE re: treatment planning AZBBHE examples:
Suaye Anna Valenti, LCSW (Case #2016-0057) Christy Maxley, LPC (Case #2016-0077) Martha Nordin, LPC, LISAC (Case #2015-0067)
State of AZ Statutes re: privilege (individual or couple)
What procedure and diagnosis codes
How to balance V-codes vs. individual
diagnoses for couples work?
How to determine when to use
90837/90847’s for individual work (i.e. 45
What does the AZBBHE, Psych Board, and
Codes of Ethics tell us about this issue?
For giggles…
Do your conclusions about any of these issues
change if the shift from individual to couple/family (or vice versa) is temporary or permanent?
If you are working with an individual who wants to
engage his/her family members in counseling, but you are uncertain of your competence to treat couples/families, are you willing to do the couple/family work if it is one or two sessions?
How might this change if they were seeking
Are you more willing to keep secrets from an
individual session if it is a one time meeting?
How might this change if they were seeking
What does the AZBBHE, Psych Board, and Codes of
Ethics tell us about this issue?
What are the potential relational consequences of moving
from individual to couple/family work (and vice versa)?
When working with an individual, how might a move to
couple/family work impact that client?
How might the client react? How might the client feel? Would this change if the move was permanent, temporary or if
concurrent sessions occurred?
How might the family members feel after beginning couple/family work
after the clinician has already seen one family member for individual work?
When working with a couple/family, how might a move to individual
work with one of the family members impact that family (i.e. one family member requests 1:1 work in conjunction with the family work)?
How might the family members react? How might they feel? Would this change if the move was permanent, temporary or if
concurrent sessions occurred?
How might the individual feel after beginning 1:1 work after the clinician
has already seen the couple/family?
What does the AZBBHE, Psych Board, and Codes of Ethics tell us
about this issue?
For giggles…
How does the clinician engage
What (if any) informed consent is necessary?
Do mandatory reporting laws apply?
What (if any) treatment forms do they
complete?
What does the AZBBHE, Psych Board, and
Codes of Ethics tell us about this issue?
case scenario? the client? the therapist?
scenario? the client? the therapist?
ACA Code of Ethics say about the issue),
should be considered)
potential effects on your relationship with each client)
Know your ethical code inside and out Read and understand the State of AZ laws a
regulations (particularly the standards of practice and the definition of unprofessional conduct)
Structure versus emotion Intuition versus rules/law Not Linear Involve others always!!!-Never isolate—get 3 opinions Don’t grocery shop when you are hungry (i.e. be
Proactive rather than reactive)
Self-care, self-care, self-care Consult, consult, consult
BEFORE shifting from individual counseling to couple/family,
following:
BEFORE shifting…Ensure sure you are competent to engage both
the individual and couple/family with their respective concerns
BEFORE shifting…Establish and CLEARLY articulate your policy on
secrets verbally and in writing
BEFORE shifting…Maintain separate files for ongoing individual and
couple/family work
BEFORE shifting…Update informed consent IN WRITING when there
has been a change in any of its elements
BEFORE shifting…Use accurate and appropriate procedure and
diagnosis codes
BEFORE shifting…Know and communicate to clients the many ways
in which they may react and feel if they move from individual to couple/family (or vice versa)
BEFORE shifting…Know and communicate the informed consent
and confidentiality requirements when engaging “consultants”/collateral contacts to the counseling process