Ethical Considerations of Marital and Family Counseling

Ethical Considerations of Marital and Family Counseling

As an undergraduate Psychology student interested in pursuing a masters in family and marital counseling, I have begun to consider the ways in which ethical dilemmas differ from individual counseling to family/marital counseling.  In the article titled “Ethical and Legal Considerations in Marital and Family Therapy” Margolin (1982) explains that “difficult ethical questions confronted in individual therapy become even more complicated when a number of family members are seen together in therapy” (p. 788).  Margolin’s (1982) article discusses the most common ethical quandaries of family/marital counseling from the perspectives of responsibility, confidentiality, patient privilege, informed consent, right to refuse treatment, and therapist values.   For the sake of brevity, the focus of this blog is on the ethical perspectives of responsibility, confidentiality, and therapist values.

 

Figure 1.  Couples Counseling.

Responsibility

            When counseling an individual, the therapist’s responsibility is to promote the wellbeing of  that client; but when counseling couples or families, what serves the wellbeing of one individual may not be in the best interest of the other(s) (Margolin, 1982).  In light of the general principles that are in place to guide ethical decisions, the principle of Beneficence and Nonmaleficence implores therapists to do good and avoid doing harm (Fisher, 2013).  In addition, code 3.04 (Avoiding Harm) puts legal responsibility on the therapist as it is expected that harm is avoided or minimized when unavoidable (Fisher, 2013).  With that in mind, it is the therapist’s ethical and legal responsibility to use sound judgment that accounts for the welfare of all individuals involved (Margolin, 1982).  

Confidentiality

            Prior to the commencement of treatment, the individual(s) seeking therapy consent to treatment after they have been provided with the limits of confidentiality in the Notice of Privacy Practices (Fisher, 2013).  The therapist is responsible for maintaining confidentiality unless code 4.05 (Disclosures) dictates otherwise.  The exceptions of when disclosure of confidential information is appropriate include:

• ·         The client consents to disclosure.

• ·         When mandated by law.

• ·         To provide necessary professional services or to obtain professional consultations.

• ·         To protect the client, therapist, or others from harm.

• ·         To obtain payment for services (Fisher, 2013, p. 346).

When treating an individual, maintaining confidentiality in most cases is less complicated since the therapist’s focus is on the wellbeing of that individual client.  However, when treating couples/families, the therapist is serving as a family advocate and must choose whether to maintain confidentiality for each person, or to hold the policy of not keeping secrets from other members in therapy (Margolin, 1982).  Because these options are at opposite extremes, Margolin (1982) offers a compromise:  seek permission from the client to use specific information when appropriate during conjoint therapy sessions.  Regardless of which confidentiality policy the therapist deems most appropriate, code 4.02 (Discussing the Limits of Confidentiality) mandates that the therapist must inform all members how confidences will be handled prior to the start of therapy (Margolin, 1982).

Therapist Values

           Since therapists are expected to do good for and avoid harming clients, it is important that they prevent their own values from affecting the course of treatment.  When considering issues that may elicit strong emotion, such as divorce, extramarital affairs, and gender roles, therapists must take special precautions to keep their values intact while simultaneously respecting each family’s values.  Margolin (1982) cited the following recommendations for therapists:

• ·         Take time to become aware of personal values

• ·         Determine how those values influence clinical practice

• ·         Inform clients of personal values that may become implicit in their therapy mode (p.799).

In summary, difficult ethical questions are likely to be present in individual or family/marital counseling.  However, advocating for the wellbeing of more than one client is likely to increase the amount of gray area in ethical decision making, especially in regards to responsibility and confidentiality.  Due to the sensitive nature of the conflicting values common to family/marital counseling, it behooves the therapist to take precaution against allowing their personal values to affect the outcome of the therapy. 

 

References

Couples Counseling [JPEG Image file].  Retrieved from URL (http://www.couplescounseling.com).

Fisher, C. (2013). Decoding the ethics code: A practical guide for psychologists (3^rd ed.). Los Angeles: SAGE.

Margolin, G. (1982). Ethical and legal considerations in marital and family therapy. American Psychologist, 37(7), 788-801. doi:10.1037/0003-066X.37.7.788