Ethical Issues In Family Services BSHS 335 / Ethics and Values For Human Service Professionals

Introduction Case 13.2 “In A Bind” Ethical Issues: Confidentiality Inform Consent Non Abandonment This case is regarding a married couple that is participating in individual and joint therapy sessions. The ethical issues we will be covering is confidentiality, inform consent and non-abandonment codes.

Client’s disclosure Informed Consent Setting Guidelines and Rules at Beginning No Secret Policy Encourage Transparency Should the therapist push the client to more fully and more honestly disclose? Yes, Dr. Martin should push Mrs. Francisco to be more honest and disclose her infidelities and plans on filing for divorce so Mr. Francisco will not be left in the blind.

Confidentiality  “Marriage and family therapists have unique confidentiality concerns because the client in a the “Marriage and family therapists have unique confidentiality concerns because the client in a therapeutic relationship may be more than one person. Therapists respect and guard the confidences of each individual client” (2015, Standard II).rape “Marriage and family therapists have unique confidentiality concerns because the client in a therapeutic relationship may be more than one person. Therapists respect and guard the confidences of each individual client” (2015, Standard II). may be more than one person. Therapists respect and guard the confidences of each individual client” (2015, Standard II). Should the therapist keep the information confidential? Dr. Martin would be violating the ethics code for confidentiality if he tells Mr. Francisco the information Mrs. Francisco does not want to disclose to him yet.

Individual vs. Couple disclosure Mistrust Disaster results Would disclosure at this time be what was best for each individual or for the couple as an entity? Full disclosure of the truth about the affair would not be 100% beneficial to the couple nor the counselor. The wife would lose trust in the counselor and husband might decide that he didn’t want to work out the marriage either. It would result in a disaster if the counselor went behind the wife’s back to tell the husband about the affair. It would also destroy the trust that might still be there. As the counselor is there to help both the wife and husband, he needs to make sure to come up with ideas that will not only help the married couple but also work on ways for the wife to be honest with her husband herself so as not to break confidentiality.

Informed consent When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual. (2015, Standard 2.2) Informed Consent is a process for getting permission before conducting a healthcare intervention on a person. Which is helpful for the helper to proceed with services that needs to be offered. With that should be the rules for how you’re going to give service and guidelines that the helper has for the client. The client should agree to these terms before moving forward with services.

Informed Consent Guidelines 1. Honesty with counselor in individual session, and complete disclosure during the individual session. This would give the counselor the whole story on why there's problems in the relationship. 2. Everything that was discussed in the individual session will be discussed in the joint session, so resolution can be sought and be moved on from. 3. All information that is disclosed once resolved can't be used against the other person. This will help with people being honest and also help with not holding things against the other person for being honest. What "rules" would you have established and shared as part of gaining informed consent prior to holding individual sessions? By establishing these rules you set the conversation with the couple to be successful and productive, because both parties can now be honest about what’s going on in the relationship. Having this in writing and explaining these rules to the client and having this informed consent in writing makes it official and that the couple both agree to the terms of the counseling.

Individual Vs. Couple’s session There should be another meeting between the two Client needs to understand the importance of disclosure Failure to be Honest Should there be another couple session? Should the therapist meet with Mrs. Francisco again to confront her failure to disclose honestly and to discuss the value of a full disclosure? In a single session Mrs. Francisco disclose to Dr. Martin that she did not want to be married anymore and was interested in someone else. In the couple session Dr. Martin expected for Mrs. Francisco to tell her husband her true feelings as she was instructed to do but she didn’t. Due to the disclosure, this put Dr. Martin in an uncomfortable position. Mrs. Francisco needs to be brought back in to discuss how important disclosure is. Also, Mrs. Francisco needs the encouragement to tell her husband the truth so she want continue to give him false hope. Prior to this session I’m sure Dr. Martin brought up and Informed Consent that she had to sign. I’m also sure that it was explained that information shared in the single session could be brought over to the joint session to try a solve any problems. Now since Mrs. Francisco has been dishonest in the couple session caused the couple’s problems to be left unresolved. Dr. Martin will further decide if another couple’s session will be beneficial, at least until Mrs. Francisco is ready to be honest to her husband. The goal is for the problem to be solved and without honesty it can’t.

Non-abandonment Marriage and family therapists do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of treatment. (2015, Standard 1.11) Dr. Martin has the option of terminating individual sessions while being the couple’s therapist. This way confidentiality and boundaries are not crossed. Before terminating a session the therapist must have a closing session with references so that the clients’ treatment is not interrupted.

Ethical Intervention Would this fail to uphold the duty to the client’s wellbeing? The information shared could fuel the sessions progress, helping both parties. There is still a responsibility to client’s confidentiality pertaining to the wife. Informed consent could change the ethics of the therapist sharing information. Would doing or saying nothing be ethical? The information given by the wife that she is no longer interested in the relationship with her husband and has in fact begun to move on already could change everything about the sessions and how the client’s wish to or should proceed. By not disclosing this information to the husband there could be the potential for causing more harm by allowing the client to have false hope or increased disappointment when the truth is finally revealed. There could also be the potential for the client to feel betrayed by both the wife and the therapist should he discover the therapist kept such pertinent information. This could also cause more harm to the client’s mental wellbeing. Doing nothing in this situation could go against the ethical standards that keep us from either intentional or unintentional harm to the client. The therapist could compromise by leading the discussions into topics that may allow for the information to come out on its own or prompt one or both clients to explore the emotions of a hypothetical scenario where one or both parties chose to end the relationship. Though the clients are in groups sessions in hopes to work on their relationship, the wife disclosed her feelings within a private session. This is still part of the therapy to work on the relationship but ultimately it is the client’s choice of when and what to say in group and or to her husband. Should the therapist decide on telling the husband, there is potential to break the ethical codes pertaining to the client’s confidentiality rights. This could be combatted by things like informed consent if established in the beginning of the sessions. By providing informed consent, you could warn the client that the information disclosed in individual settings would eventually have to be brought into the group sessions whether it be through the client or the therapist.

References Parsons, R.D., & Dickerson, K. (2014). Ethical Practice in the Human Service, Retrieved from https://phoenix.vitalsource.com/#/books/9781506332925 American Association for Marriage and Family Therapy. (2015). Code of ethics. https://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/code_of _ethics.aspx