The significance of culture and values in Family and Marriage therapy can never be over emphasized. This is why the therapists in this field must understand that a good therapy intervention is one that places the needs of the clients above that of the therapist’. There are lots of interaction methods out there, and therapists must familiarize themselves with all the different models and theories. A good therapist must also have a sound knowledge of ethical and legal issues as well as the necessary state and federal laws.
A therapist may find himself in an unfamiliar situation where he doesn’t know how to react or the best way to proceed. In situations like this, therapists are encouraged to apply their personal judgement and make sure they arrive at an outcome that is favorable to the client and all the parties involved (Wilcoxon, Remly & Gladding, 2013).
If a therapist is unsure or needs to seek additional information on the best way to proceed, the therapist can seek further assistance from sources like the CAMFT or AAMFT Code of ethics, colleagues, attorneys, etc.
I will be addressing some of the challenges faced by therapists such as neglect, abuse, mandatory reports, confidentiality, non-abandonment, client’s note, non-discrimination and therapy termination, in this paper. The following client situations, will serve as a guideline in this discussion: A boy of 10 was brought into therapy by his mother after exhibiting disruptive behavior at school. The boy’s father was also in support of taking the boy into therapy. The therapist will try to establish a good relationship with the boy so as to help him work through his issues.
Scenario 1 – Mother’s Request
Children often exhibit different behavioral patterns at home and in school. Having a therapist in such situations is very important since they are trained to help parents understand their kids better and help them handle such behaviors, thereby improving family relationships. Therapists are often involved in different challenging situations when handling their clients, and may need to collaborate with other healthcare providers like Pediatricians, Specialists, or Primary Care Physicians where such a client has been diagnosed with a condition that requires the services of a family counselor. A therapist may need to provide these professionals with certain information on their treatment plan for the client’s best interest. This is one of the functions of the Code of Ethics, which is designed to provide a guide for therapists when handling their client’s welfare, maintaining high degree of competency, and ensuring that client information stays confidential (Wilcoxon, Remly & Gladding, 2014).
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This case is a perfect example of how a therapist can maintain high standards by keeping good practice. It is important for therapists to follow all the necessary steps if a legal guardian or parent of a minor requests to share confidential information about the therapy with other parties to avoid liability for illegal practices. The minor in this example is 10 years old, which means the therapist must follow the appropriate protocol under California state laws including CAMFT and AAMFT Code of Ethics. Client information should not be shared with a third party unless the client in question agrees to it in writing or where it is very essential for therapy.
According to Standard 2.2 of the AAMFT Code of Ethics, every therapist must obtain written authorization before releasing their client’s information (AAMFT-Code of Ethics, 2015). The client-therapist relationship can easily be damaged if good judgment is not employed when handling client information (Wilcox, Remley & Gradding, 2014). However, if a client gives written approval to a therapist, then the therapist can go ahead and pierce the veil of confidentiality. The CAMFT Code of Ethics Standard 2.2 provides that parents must provide written approval before a therapist can share confidential information about their ward and the information should only be discussed in furtherance of the purpose of release (CAMFT Code of Ethics, 2015).
Parents and guardians have a right to know that the information provided will be safeguarded and protected at all time. Therapists are encouraged to document every confidentiality and privacy information on how the information is managed and all the policies relating to the privacy of the client and make sure it is signed by the client to avoid legal issues
Scenario 2 – Father’s Punishment
Child abuse is a prevalent topic in therapy. Therapists are mandated to report what happens, regardless of whether they think the child is lying, or whether or not they think the abuse occurred. The therapist is duty-bound to document any statement made by the client and note all the occurrences and details (sexual abuse, corporal punishment, physical injury). The law does not mandate therapists to investigate whatever they’re told by their clients; their duty is to report to the appropriate authorities. Per the California Penal Code Child Abuse it is the therapist’s responsibility to protect a child of any physical abuse or neglect.
The allegation of abuse reported to the therapist in this particular case is a serious one and must be reported to the appropriate authorities at the earliest opportunity or in the first thirty-six hours of receiving the report of abuse. The law makes specific provisions on how the first report should be submitted. You can contact Child Protective Services (CPS) or any law enforcement agency by fax, phone or any other electronic means available to make a report.
The California Penal Code provides that the report must contain the name of the therapist, the business information (phone number and address), capacity of the reporter, and the details of the abuse and the source of the information. The therapist must also include pertinent information about the child like name, phone numbers, address, name of parents or legal guardians, school information, present location and information on the alleged perpetrator (“California state law”, n.d.).
According to the Penal Code, a family therapist that fails to report abuse to the authorities after hearing of it could face several risks. The risk could involve paying a fine or being charged for a misdemeanor. In addition, the therapist could face legal actions from the BBS or have his license suspended.
Therapists must keep abreast of the necessary laws to acquaint themselves with the current charges. You can also seek legal help or consult with an expert when in doubt. It is important to document proceedings if you suspect abuse or when a client is reporting abuse.
Scenario 3 – Family Session
Family therapists are often encouraged to maintain the highest ethical standards and avoid unethical practices in their dealings with their clients (Wilcox, Remley & Gradding, 2014). They’re enjoined to put their client’s need first. This is why you need to set boundaries when dealing with clients. Therefore, your intervention should not go beyond what is required of you according to the goals set for the treatment plan. Therapists are advised to use their critical thinking when making certain decisions. Having dual or multiple relationships with a client is a great example of this. This behavior is unethical
According to CAMFT, a dual relationship with a client occurs “when a therapist and his/her patient engage in a separate and distinct relationship either simultaneously with the therapeutic relationship, or during a reasonable period following the termination of the therapeutic relationship” (CAMFT Code of Ethics Standard 1.2, 2015). AAMFT also provides that engaging in multiple relationships “could impair professional judgment or increase the risk of exploitation” (AAMFT Code of Ethics Standard: 1.3, 2015). Such unethical behaviors are discouraged because the status or power of the therapist and client are very different.
This particular case is an example of the importance of maintaining a healthy therapist-client relationship. Boundaries are very important because it can lead to impaired judgment if crossed. Knowing the father is not an excuse, the therapist must exercise utmost professionalism in all his/her dealings and work hard to achieve the set goals in an atmosphere of trust and mutual respect. A therapist should not act in fear or take sides. The therapist must act with integrity and exhibit competency at all times.
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If the therapist has doubts about his/her ability to manage such a situation, then the therapist ought to seek counsel from an attorney or a colleague. Having a dual or multiple relationship could cause a great deal of harm to parties involved or lead to conflict of interest. In essence, a therapist must always put the welfare of the client first (Wilcox, Remley & Gradding, 2014).
Scenario 4 – Post 10 Sessions
Credentialing process, rejection, denials, length of time required for processing payments, panel issues when it closes the acceptance of mental health providers, etc. are some of the issues experienced by therapists working with managed-care organizations. These challenges have a lot of impact on the clients and the overall business. Not everybody can afford counselling services. This is why therapists and prospective clients are enjoined to use their insurance to obtain the services they require.
However, problems might arise when an insurance company sends a notification to a client declining the approval of additional therapy sessions when treatment is still going on. On the other hand, a client may not be able to afford the session out of pocket. In such situations, therapists will have to use their professional judgment in other to avoid any unethical practice. A therapist can also decide to terminate the services when this occurs.
Therapy termination is usually discussed at the start of therapy and included in the treatment plan (Gehart, 2014). A lot of reasons can cause a therapist to terminate treatment. It could be that they have met the goal specified in their treatment plan, the client feels confident enough to manage the issues or both the therapist and the client are aware that the therapy has not been effective so it needs to come to an end (AAMFT Ethics of Code, 2015). Also, a therapist who is unable to continue treatment with a client should make alternate arrangements for the treatment rather than leaving the client to his own device (AAMFT Code of Ethics Standard 1.11, 2015). CAMFT also makes regulations for therapists on how to handle financial arrangements (CAMFT Code of Ethics Standard 9, 2015).
This example presents a case on the need for therapists to be ethical in their dealings. Therapists must learn to engage in good practices to avoid liabilities. This can be achieved by disclosing all fees paid at the start of treatment, avoid discrimination, encourage clear communication to avoid misunderstandings, avoid accepting payments in form of merchandise, and make sure you make arrangements for the transfer of clients to another therapist if termination occurs.
Scenario 5 – One Year after Termination
Most therapists have clients who are in the process of getting a divorce. When both parties decide that their marriage has become irretrievably broken, they file a divorce petition (Wilcox, Remley & Gradding, 2014). Therefore, family and marriage therapists must equip themselves to help such couples get through this process and interpret court terminologies for them if necessary. This could involve a spouse requesting for alimony, custody battles, sharing of joint properties, etc. The therapists must understand the context of each issues and suggest how best to serve the client, while helping to simplify the litigation process. One of the challenges faced by therapists in this circumstance is getting subpoenaed by the court to take part in a proceeding involving one of your clients.
A therapist who has being subpoenaed to testify in a court proceeding for a client who is in the process of getting a divorce must follow good practice. The law in California is primarily interested in determining “what is in the best interests of the child” whether or not the parental rights have been determined (California Family Code 175, n.d.). therapists are also enjoined to follow the procedures laid down by the HIPPA (Health Insurance Portability and Accountability Act) for keeping client’s records. Every information gathered during therapy is contained in the client files including additional information like messages, calls, letters sent to client, etc. Before a therapist submits client record for court proceedings, the therapist must first obtain written consent from both parents and must only discuss matters needed to further the purpose of the said release. This is done to protect the privacy of the client (AAMFT Code of Ethics Standard 2, 2015).
According to California’s Code of Ethics, a therapist who is asked to serve in the capacity of an evaluator must discuss the consequences of switching from therapist to evaluator with both parents (CAMFT, 2015). Therapists must familiarize themselves with the necessary judicial and administrative rules (Wilcox, Remley & Gradding, 2014). This is because, therapists must not provide misleading information during their testimony and must avoid providing inappropriate data or exhibiting impartiality (CAMFT Code of Ethics Standard 8.1, 2015).
SOAP is one of the tactics employed by therapists for recordkeeping (Cameron & Turtle-Song, 2002). This tool is made up of four components and is great for managing client progress. SOAP noting is used to record client information and contains what is said by the clients (subjective), your observations or specifics (objective), the insight provided by the therapist (assessment) and the next course of action (plan).
The subjective component includes the therapists’ record of the history of stressors, child abuse or behavioral changes with notes about the client, his feelings about family, goals, concerns and plans. The objective component involves a recording of the therapist’s observations about things like client’s appearance, strength of the therapeutic relationship and behavior of family members (Cameron & Turtle-Song, 2002). The therapist in this section can add reports from the client’s physician on the sleeping disorder diagnosis. The assessment component involves the therapist describing the clinical information on every family member in details including clinical impression about all the members, DSM-IV-TR diagnosis and a description of the process by which the therapist arrived at the clinical diagnosis. Plan is the last component and includes the necessary plan of action (interventions, educational instructions, date of next appointment, treatment direction and treatment progress) and the therapist’s prognosis (Cameron & Turtle-Song, 2002).
From the above case, the following is a great example of the SOAP process: 7/31/2016 1 pm. (S) Reports about some behavioral issues at school and home. There is a history of physical and emotional abuse and the father is the alleged perpetrator. Parents are in the process of getting a divorce. According to recent history: the pediatrician diagnoses sleeping disorder. (O) There is rage, fear and sadness. (A) there is emotional and physical abuse (DSM-IV-TR V61.21) violent behaviors without any known emotional trigger. (P) Reschedule for 8/8/16 at one p.m. Retain the Cognitive Behavioral Therapy.
SOAP noting helps therapists to monitor the progress of their clients and adapt their treatment plan according to their observations. An example is when a child communicates the emotional and physical abuse he is undergoing during an intervention. And the therapist using the information communicated to update his/her treatment plan to reflect the new goals for handling the new information.
Therapists should learn to use this noting method wisely and only include information required for the treatment plan like objectives, goals or new issues. The notes should align with the therapist’s level of expertise. You must also cross-check the information contained in your files to ensure that there are no errors (spelling, grammar, unclear terminologies, accents, etc.)
Counselors are saddled with the responsibility of assisting their clients and applying the right ethical practices when handling the client’s welfare. Therapists may face different challenges, but they must learn to make the right decisions and comply with the necessary rules and regulations to avoid liability. Therapists must also find ways to acquire the knowledge needed to succeed in their chosen field (Wilcoxon, Remly, & Gladding, 2014).
- Gehart, D. R. (2014). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. Belmont, Calif: Brooks/Cole Pub.
- Wilcoxon, A., Remly, T., & Gladding, S. T. (2014). Ethical, legal, and professional issues in the practice of marriage and family therapy. 5th ed. Upper Saddle River, N.J.: Pearson Merrill Prentice Hall.
- Association for Advanced Training in the Behavioral Sciences (AATBS) materials The California MFT
- California Statutes Related to Child Abuse and Neglect. (n.d.). Retrieved from http://www.scdha.org/Professionals/docs/2010HandOuts/N_South%20Carolina%20Statut
- Cameron, S., & Turtle-Song, I. (2002). Learning to write case notes using the SOAP format.http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=7164780&site=ehost-live
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