Table Of ContentEthics and ProfEssional issuEs
in couPlE and family thEraPy
Ethics and Professional Issues in Couple and Family Therapy, Second Edition,
builds upon the strong foundations of the first edition. This new edition
addresses the 2015 American Association for Marriage and Family Therapy
Code of Ethics as well as other professional organizations’ codes of ethics,
and includes three new chapters: one on in-home family therapy, a com-
mon method of providing therapy to clients, particularly those involved
with child protective services; one chapter on Health Insurance Portability
and Accountability Act of 1996 (HIPAA) and Health Information Technol-
ogy for Economic and Clinical Health (HITECH) regulations that practic-
ing therapists need to know; and one chapter on professional issues, in
which topics such as advertising, professional identity, supervision, and
research ethics are addressed. This book is intended as a training text for
students studying to be marriage and family therapists.
Megan J. Murphy, PhD, LMFT, is an associate professor and director of the
Marriage and Family Therapy Program at Purdue University Northwest in
Hammond, Indiana. She currently serves as a commissioner on the Com-
mission on Accreditation for Marriage and Family Therapy Education and
was a coeditor of Families Across Time: A Life Course Perspective (Oxford
University Press, 2000).
Lorna Hecker, PhD, LMFT, is a professor and director of the Couple and
Family Therapy Center at Purdue University Northwest in Hammond, Indi-
ana. She is Certified in Healthcare Privacy and Security expertise in HIPAA
and HITECH regulations. She edited the first edition of E thics and P rofessional
Issues in Couple and Family Therapy, and her previous publications include
The Therapist’s Notebook: Homework, Handouts, and Activities for Use in
Psychotherapy (Volumes 1, 2, and 3), The Therapist’s Notebook for Children
and Adolescents, and An Introduction to Marriage and Family Therapy
(Routledge). She also authored the book HIPAA Demystified: HIPAA
Compliance for Mental Health Professionals (Loger Press).
“The second edition of the Murphy and Hecker book is excellently writ-
ten with illustrative case vignettes and is even more comprehensive than
the original version. The additional chapters about HIPAA and HITECH,
home-based therapy, and professional private practice issues make the
book a must for all C/MFT training programs and private practitioners.”
—Volker Thomas, PhD, LMFT, professor of couple and
family therapy, University of Iowa (retired)
“Ethics and Professional Issues in Couple and Family Therapy is full of pre-
ventive care and interventions for couple and family therapists in clinical
practice. The distinguished editors and contributors provide pages of prac-
tical suggestions and recommendations to maintain best practices. The
authors took great care to untangle complex ethical, legal, and technical
issues, which makes the book an easy, but informative read for experienced
clinicians and CFT students. The culturally diverse case examples illustrate
how therapists can avoid common pitfalls inherent in clinical practice and
the importance of self-care. This book should be a required reading for
students in CFT programs!”
—Stephanie Brooks, PhD, LCSW, LMFT, chair, Couple and Family
Therapy Department; associate dean, Graduate Health
Professions, Drexel University
“This is an indispensable resource on ethical issues in the practice of couple
and family therapy. The second edition includes a comprehensive review
of new HIPAA and HITECH regulations, and the latest AAMFT code of
ethics. Clear and concrete examples are used to drive home major points.
I highly recommend this book to any couple and family therapy student,
instructor, or licensed provider.”
—Andrea K. Wittenborn, PhD, graduate director, associate
professor, Human Development and Family Studies,
Michigan State University
Ethics and
ProfEssional
issuEs in
couPlE and
family thEraPy
second Edition
Edited by Megan J. Murphy
and Lorna Hecker
Second edition published 2017
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2017 Taylor & Francis
The right of Megan J. Murphy and Lorna Hecker to be identified as the authors of the editorial
material, and of the authors for their individual chapters, has been asserted in accordance with
sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. The purchase of this copyright material confers the right on the purchasing
institution to photocopy pages which bear the photocopy icon and copyright line at the bottom
of the page. No other parts of this book may be reprinted or reproduced or utilised in any form
or by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
First edition published by Routledge 2009
Library of Congress Cataloging-in-Publication Data
Names: Murphy, Megan J., editor. | Hecker, Lorna L., editor.
Title: Ethics and professional issues in couple and family therapy / edited by
Megan J. Murphy and Lorna Hecker.
Description: Second edition. | New York, NY: Routledge, 2017.
Includes bibliographical references and index.
Identifiers: LCCN 2016019391 | ISBN 9781138645257 (hbk: alk. paper) |
ISBN 9781138645264 (pbk: alk. paper) | ISBN 9781315628240 (ebk)
Subjects: LCSH: Family psychotherapy—Moral and ethical aspects. | Marital
psychotherapy—Moral and ethical aspects. | Family therapists—Professional ethics. |
Marriage counselors—Professional ethics.
Classification: LCC RC488.5 .E87 2017 DDC 616.89/1562—dc23
LC record available at https://lccn.loc.gov/2016019391
ISBN: 978-1-138-64525-7 (hbk)
ISBN: 978-1-138-64526-4 (pbk)
ISBN: 978-1-315-62824-0 (ebk)
Typeset in Minion Pro
by codeMantra
Contents
Preface vii
1 Introduction 1
Lorna Hecker and Megan J. Murphy
2 Ethical Decision-Making from a Relational Perspective 17
Elisabeth Shaw
3 Legal Issues in Couple and Family Therapy 37
Ruth Ogden Halstead and John H. Halstead
4 The Impact of HIPAA and HITECH Regulations on
the Couple and Family Therapist 59
Lorna Hecker, Courtney L. Miner, and Megan J. Murphy
5 Self of the Therapist: Being Aware, Prepared, and Ethical 81
Jared A. Durtschi and Melanie McClellan
6 Power, Privilege, and Ethics in Couple and Family Therapy 99
Megan J. Murphy and Lorna Hecker
7 Sexuality, Boundaries, and Ethics 121
Teresa L. Young and René A. Jones
8 Risk Management in Practice 141
Amber Sampson
9 Spirituality and Religion 163
Rebecca A. Cobb, Jacob B. Priest, and Taimyr B. Strachan
10 Ethics in Therapy with Children in Families 183
Lorna Hecker and Catherine Ford Sori
11 Ethical, Legal, and Professional Issues in Mediation
and Parent Coordination 205
Julia M. Bernard, Nicole Manick, and Maike Klein
v
vi Contents
12 Ethical Issues in Clinical Practice 223
Z. Seda Sahin and Julie Ramisch
13 Ethical Issues with Systemic and Social
Constructionist Family Therapies 243
Joseph L. Wetchler and Rachel M. Moore
14 Ethical Couple and Family E-Therapy 261
Markie L. C. Twist and Katherine M. Hertlein
15 Ethical and Clinical Considerations for
Home-Based Family Therapy 283
Kiran M. Hussain, M. Evan Thomas, Shannon Polezoes,
and Léa El Helou
16 Ethics of Professionalism 299
Megan J. Murphy and Amber Sampson
Index 319
Preface
Primum non nocere—First, do no harm.
Hippocrates (c. 460–400 BC)
You likely chose the field of couple and family therapy because of a desire
to help people and would likely be aghast at the notion of harming your
clients. Yet without proper knowledge, you can make decisions that can
indeed cause harm to clients, your own professional practice, the larger
professional field, and yourself. The chapters in this book have been c hosen
to educate you on the most salient topics regarding the intertwining of
ethical, legal, clinical, and professional issues faced by couple and family
therapists.
This book is a revision on the first edition, edited by Hecker in 2010.
This book grapples with contemporary ethical and professional issues,
some of which have changed or recently arisen or transformed since that
writing. For example, in this edition, linear decision-making is replaced
with a relationally focused ethical decision-making process that relies
much more on clients’ context and the responsibilities therapists have to
consider when making ethical decisions with clients. Power and privilege
issues have been updated to include a focus on power issues that arise in
choice of our theories, the therapeutic relationship, and in clients’ relation-
ships with each other. The power of a therapist with regard to maintaining
sexual boundaries and how to handle sexual harassment is detailed. The
complexity reflected in intersectionality is introduced.
A new standard of care has arisen with privacy protections for our cli-
ents’ oral, written, or digital private information, with the advent of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA) as
well as the subsequent Health Information Technology for Economic and
Clinical Health (HITECH) Act of 2009. HIPAA audits were mandated by
HITECH, and lawsuits are beginning to occur using HIPAA regulations
as the standard of care for client privacy protection, whether or not you
vii
viii Preface
are a “covered entity” under the regulations. HIPAA security regulations
stress the importance of maintaining privacy of digitally stored client data,
which can be overlooked by more of us who favor “high touch” over “high
tech.” Specific information around ethical issues within e-therapy is also
discussed, with a framework from which to conceptualize e-therapy clini-
cal and ethical issues presented.
Couple and family therapists’ entwinement with the legal system is
explored, educating the reader on properly responding to a subpoena, while
still focusing on the ever-important duty to warn or protect. Additionally,
career opportunities that intersect with the legal system such as the role
of a couple and family therapist as mediator and parent coordinator are
explored. As we look at CFT involvement with custody issues on children,
we also address the increasingly recognized phenomenon of parental
alienation from a child.
In our first edition, office policies and procedures were explained; in
this book, we also delve into requirements to establish a private practice,
including information on opening a business, applying to insurance pan-
els, and necessary documentation.
We recognize that more and more therapists are providing in-home
family therapy, which evokes particular attention to ethical principles,
including confidentiality, boundaries, and safety. Self-of-the-therapist
issues are addressed and include knowing one’s own values, implement-
ing a program of self-care, and warning signs for burnout and compassion
fatigue. Finally, we have added a chapter on ethics of professionalism—to
remind us that we represent our professional fields through our actions
and behaviors. We are indeed connected to something larger than our-
selves—the field of family therapy.
This is a book for professionals who want to understand the context of
complex situations in which couple and family therapists find themselves.
It is a book for couple and family therapists who, consistent with their sys-
tems training, will grasp multilevel problems, grapple with them, and go
through a reasoned analysis to find a solution that best meets the needs
of the people involved. As in the 2010 edition of this book, readers are
introduced to ethical principles for consideration in ethical deliberation
and decision-making. In an ideal world, all therapists would be trained in
moral philosophy; that ideal is clearly outside the scope of this book. This
book can be used as an introductory graduate text in marriage and family
therapy graduate programs, professionals wishing to expand their depth
and understanding of the field, or by those refreshing their knowledge of
professional issue and ethics for licensing exams.
Preface ix
You will no doubt have quandaries when faced with ethical dilemmas
posed in this book. Answers to ethical dilemmas often introduce com-
plexity for which answers to those dilemmas also result in a refrain of “it
depends.” Many variables contribute to evaluation when making sound
ethical decisions. A tolerance of ambiguity is necessary for anyone who
truly wishes to struggle with ethical dilemmas. You have to be able to
juggle many diverging solutions (and viewpoints) at once before the best
action can be chosen. Sometimes the best solution is obvious; other times,
there are competing “best” courses of action. Sometimes, all alternatives
to an ethical dilemma simply are not satisfying or can even be repugnant.
Early foreclosure on decisions to decrease your accompanying anxiety can
lead to situations (ethical, clinical, or legal) that are worse than the pre-
dicament that was initially raised. Although some ethical/clinical decisions
need to be made quickly, there are many situations in which the therapist
can decelerate the process to thoroughly scrutinize the situation at hand.
In this book, you will find numerous case scenarios, many based on
actual experiences to give the reader a sense of the richness of ethical issues
that may present themselves in therapy. In some, the ethical or legal issues
at hand may be quite evident, whereas in others it may be subtle and you
will need to search for the shades of gray that continuously make ethics a
challenging but worthwhile pursuit. All case scenarios have had identify-
ing information of the clients and case-specific information altered to pro-
tect the confidentiality of the client.
Unfortunately, in our personal experience, we have encountered thera-
pists who have not followed the “do no harm” dictate and have hurt people
when they violate their professional and moral responsibilities. In some
circumstances, there has been egregious harm. We have seen others believe
that they are without moral fault—this alone is a dangerous stance. The
people who believe themselves to be without moral fault put themselves
outside the realm of dialogue, and relationships become secondary to their
agenda. Dialogue is key to resolving most ethical dilemmas. It our hope
that you engage in much dialogue as you traverse this book. It is our quest,
then, that therapists be educated about ethics for the very positive goal of
helping clients, but at the very least, Primum non nocere. This book pro-
vides education, insight, and tools to help you adequately prepare for ethi-
cal practice as a couple and family therapist.
