Ethics Code Provides Opportunities
As reported in the December 2000/January 2001 Family Therapy News, the AAMFT Board of Directors has approved revisions to the AAMFT Code of Ethics which will go into effect July 1, 2001. The entire Code was printed in the Family Therapy News, and it can also be viewed and downloaded at http://www.aamft.org/about/RevisedCodeEthics.htm.
Clinical supervisors are responsible for monitoring the practice of their supervisees, and of course ethical consideration should be interwoven throughout supervision. The release of the revised Code provides supervisors with an additional opportunity to devote supervision time to a discussion of ethical principles. I intend to spend considerable time on this with my supervisees, and believe that revisiting the subject of ethics outside of the context of a specific case will provide for an excellent learning exchange.
I suggest that discussions of the "new" Code focus not just on the revised portions. In fact, the number of blatant ethics violations for even the most basic ethical principles (confidentiality violations, sex with clients, as examples) suggests that repeated reminders of ethical principles are in order. Discussions of ethical principles should strive to move beyond a recitation of dos and doníts, to an understanding of how ethical principles can affirmatively guide oneís practice. Below, I will suggest some opportunities for discussion with supervisees. (Note: numbers in parentheses correspond to subprinciples of the Code.)
The therapistís responsibilities to clients is perhaps the most important tenet in ethical therapy, thus its prominence as the first principle addressed in the AAMFT Code of Ethics. The 2001 Code rephrases the anti-discrimination subprinciple (1.1) as an affirmative obligation, and expands the classes of people mentioned. Informed consent is emphasized and described (1.2). I suggest particular attention to this section, since informed consent is too often passed off as merely administrative, without proper consideration for its importance in the protection of clients.
The subprinciple on "dual relationships" was rephrased to emphasize the protection of clients. The concern is not the mere existence of a dual relationship, but the risk of the therapistís judgement being impaired or of the client being exploited. The prohibition against sexual intimacy with clients is emphasized (1.4), and there is still an absolute prohibition for two years following therapy. However, the 2001 Code rejects any notion that harm will not occur simply by letting a two year period pass, and places the burden on the therapist to avoid exploitation no matter how much time has passed.
Other elements to highlight from this section include the concept that therapists will continue seeing a client only so long as the client will benefit (1.7), and will appropriately refer any client the therapist cannot help (1.8). Not every therapist is good for every client, a notion that is often overlooked as trainees strive to demonstrate their competence. The AAMFT Code of Ethics provides excellent guidance for MFTs when this situation arises.
Principle II focuses on a therapistís obligation to maintain confidentiality. While the basic concept on confidentiality seems simple enough, most supervisees will be able to provide conundrums from their own practice that point out the
complexity of confidentiality in real practice. Areas to emphasize in a supervisory discussion include ensuring that clients understand possible limits to confidentiality (2.1), maintaining confidentiality when transferring records (2.5), and managing confidentiality when consulting with colleagues or referral sources (2.6).
Principle III discusses professional competence and integrity. The new Code emphasizes that therapists should not practice new techniques or specialties without the proper education and supervision (3.6), and reminds therapists that there is an ethical obligation to stay abreast of developments in the field (3.5). Supervisors should have a clear understanding with their supervisees about what types of practices, ideas, or techniques should be discussed in supervision before being applied.
Principle IV addresses the therapistís responsibilities to students and supervisees. To emphasize the prohibition of providing therapy to students and supervisees (4.2) and against sexual intimacy with students and supervisees (4.3), the 2001 Code makes these statements separate subprinciples. It goes further in prohibiting the acceptance of students and supervisees with whom the supervisor has a prior or existing relationship which could compromise the supervisorís objectivity (4.5). Discussion of principle IV can reemphasize the supervisorís concern for ethical conduct in both supervision as well as therapy, and opens the door to a broader discussion of the supervision contract with that particular supervisee.
Responsibility to research participants is the subject of Principle V, which had only minor, editorial changes in this revision of the Code. It should not be overlooked, even if research is not actively being conducted with the cases under supervision. As is the theme throughout the Code, informed consent and protection of the research subjects is emphasized.
Principle VI addresses responsibility to the profession. It provides guidance to employees when their organizational requirements conflict with the Code (6.1). Specifically, the therapist is obliged to notify the employer of the conflict and his/her desire to abide by the Code, and to make every effort to resolve the conflict in a way that adheres to the Code. Interns and supervisees from other work settings can be invited to explore instances where this may have occurred or may be occurring. This section of the Code emphasizes that therapists do not plagiarize or fail to cite authorship when due (6.3 and 6.4).
Principle VII focuses on financial arrangements, another area often overlooked in supervision because of its administrative connotation. This issue is important to clients, making it a critical topic for supervision. Perhaps most important is ensuring that clients are well informed about what therapy will cost, and what will happen if the client becomes unable or unwilling to pay for services (7.2). For example, therapists generally cannot withhold records solely because payment has not been received (7.6). In an age when creative moneymaking is encouraged, therapists are prohibited from receiving payment for referrals (7.1), and must tread carefully if entering a bartering situation (7.5). Ask to see any documents your supervisee is using with clients to explain the costs and collection procedures for therapy, and discuss them in light of these ethical principles.
Those familiar with the earlier version of the AAMFT Code of Ethics will notice that Principle VIII, which addresses advertising by MFTs, is streamlined in the new version. The basic notion here is that advertising should be honest, and not misleading. As a regular practice, I ask my supervisees to see their business card and stationery, and ask to see any advertisements they run. This provides the supervisor with an opportunity to discuss any ways in which the statements, degrees, affiliations, licenses or designations should be altered to avoid misinterpretation.
Supervisors have enormous responsibilities to supervisees, their
clients, and the MFT profession. Clearly, competent practice as a
supervisor must include significant attention toward the training of
supervisees in the application of the AAMFT Code of Ethics within