1. Balancing effects of internal/external factors is critical for therapist's decisions

2. Every member of a couple/family system has unique psychological worldview from their personal acculturation

3. Systemic dynamics sometimes create crises that hold implications for value-sensitive care

4. The ecology of therapy includes divergent values and forms of power that affect therapy with couples and families

5. Therapists' professional acculturation promotes ethical duty to the foundational ethical principles

6. Mandatory ethical decisions are straightforward, but discretionary ethicals decisions occur w/in range of acceptable actions; ethical risk increases with multiple clients

7. Many traditions of ethical therapy decisions are grounded in a therapy model with individual clients; ethical matters unique for intervention

Multiple clients in MFT can create dilemmas for therapists in that: (3)

1. An intervention that serves one member’s best interest may be counter-therapeutic to another

2. Inequalities of power and rights also become matters across household generations

3. External agencies affecting the ecology of therapy become matters of institutional values affecting clients and therapists

3 ethical principles can converge to create significant difficulties when serving multiple clients:

1. Autonomy

2. Beneficence

3. Justice

MFTs assume complex responsibility for judgments about the welfare of more than one individual. Equally significant in such judgments is the effect of institutional values that may require the therapist to “pathologize” an individual member in order to permit services.

In such situations, the ethical principle of _____ must be considered.

The therapist can respond to this dilemma of conflicting interests by…

Justice

…identifying the marital or family system rather than a single individual as the “client”

Various ethical codes address the issues of identity, rights, and service to multiple clients, stating that when psychologists agree to provide services to several persons who have a relationship, they must take reasonable steps to clarify at the outset: (4)

1. Expectations and limitations of confidentiality w/ each individual

2. Which individuals are identified as the primary clients

3. Relationship the psychologist will have w/ each person

4. Obligations to an individual, couple, family, 3^rd party, or institution

For system advocates, the complex nature of managing decisions and attempting outcomes for multiple clients means that due care often…

…goes beyond the specific and sometimes self-centered goals of individual members.

Multiple clients create multiple considerations for practitioners, and establishing clients’ rights and authority is critical at the outset of therapy. These rights begin with ____________.

Confidentiality

MFTs must not only inform clients in individual therapy of the limits of confidentiality, but have an additional obligation toward marital partners or other family members: They must decide what confidentiality means for the couple or family group, and how it will be maintained.

Generally, issues of confidentiality that are unique to MFT are in 2 areas:

1. Secrets

2. Changes from systemic to individual formats

Families tend to have 3 types of secrets:

1. Shared family secrets

2. Internal family secrets

3. Individual secrets

Family secrets tend to fall into 3 different types of categories:

1. Taboo Topics

2. Rule Violations

3. Conventional Secrets

Taboo Topics

Rule Violations

Conventional Secrets

1. Treat each partner or family member's confidences as thought that person were an individual client.

• Info obtained in private session, phone call, or written material is not divulged to the other
• Often arrange for sessions w/ individual members to actively encourage sharing of secrets to understand what is occuring in relationship system
• Work toward goal of enabling that individual to disclose in family session

2. Policy of nonsecrecy

• Discourages sharing of info that might lead to or maintain an alliance btw therapist and one member, or btw members
• Avoid receiving individual conferences, and conduct only conjoint or family sessions

In regards to confidentiality issues with multiple clients, some have advocated a distinction between secrecy and privacy in terms of…

An incident which is now reasonably resolved and not significantly affecting the present relationship (e.g. childhood trauma), would be considered _______.

• A client may at some time choose to share this history with members, but does not owe it to them to do so.

Private

Withholding of information that involves deception as well as a violation of trust would be considered ________.

Secret

Confidentiality obligations are complicated when a change in the format of therapy takes place from individual therapy to the inclusion of a partner, spouse, or other family members.

2 critical issues to address when considering such a change include:

1. How the therapist should handle the info obtained during individual therapy; may/may not receive permission to share

2. Even if client permits info to be shared, permission granted after info was obtained; client may not remember all that was confided

The application of confidentiality in the legal sphere is subject to the state laws concerning ________.

Privileged Communication

Most privileged communication statutes tend to be ill defined for situations in which two or more clients are seen simultaneously. For example, in some states: (2)

1. Presence of a 3rd party is contrued to mean that necessary confidentiality is lacking, and thus the therapist-client privilege is deemed lost or waived.

2. Questions as to whether privilege applies to client-to-client communications arise as some states extend privilege to persons who aid in delivery of personal services (e.g. nurses, med technicians); a liberal interpretation can identify family members as agents of the therapist

As one considers the application of confidentiality and its derivatives (i.e. privacy, privileged communication, and duty to protect), it becomes apparent that therapists must be deliberate in clarifying circumstances and expectations for discloses to other family members or those outside the therapy system.

Clients have fundamental rights to regulate information relevant to their welfare and to clarify their expectations for therapy. Such information is addressed through procedures of ________.

Informed Consent

The process by which a dyadic emotional system encompasses a third system member for the purpose of maintaining or establishing homeostatic balance.

• two-person emotional systems become unstable in the face of conflict and stabilize by forming three-person systems
• "balance" created by "imbalance" of alliances

Triangulation

ex) Therapist may become "triangulated" in a conflict btw 2 members