Confidentiality, integrity, and professionalism in marriage and family therapy

¶ … confidentiality, integrity and professionalism in the field of marriage and family therapy. The writer explores the issues and ethics surrounding family therapists and their obligation and duty to maintain the above qualities within their practice. There were 20 sources used to complete this paper.

For some families by the time they call the family therapist it is a last resort. They have spent months if not years trying to resolve the internal conflict on their own to no avail. In addition by the time they make that call for help one or more of the family members may have already given up and the therapy is a last ditch effort to save the marriage or family unit. For those who have not struggled for years but are making the call, it can be a court ordered situation which places all family members on the defense. They are embarrassed to be under a court order to seek help and they are not sure what the therapist is going to think of them and the actions that got them there. For still others the decision to seek therapy may have been put off because the participants are well-known in their community, perhaps famous and there is a concern if the word gets out reputations will be harmed. For the clients of marriage and family therapists there are many sets of circumstances that caused them to seek help but the common denominator among the groups is the need for privacy.

Therapy can be extremely painful processes under which the participants must open old wounds, explore buried emotions and reach out to those they are most afraid of losing. It is a situation that can be extremely emotional and filled with trust issues and lack of security. The participants must be able to trust that their therapist will maintain the highest standard of integrity and ethics when it comes to their needs (Vye, 2005).

With the many reasons people go into therapy, coupled with the need for them to be able to trust their therapist with their feelings and emotions the marriage and family therapist is held to an extremely high standard when it comes to professionalism, integrity and confidentiality.

Ethics

In the field of marriage and family therapy the question of ethics is a never ending oasis of debate. While there are certain ethical standards that are mandated by law, there are other areas of professional ethics that are subjective, therefore open to individual interpretation. The ethics and integrity of the individual therapist can have as much impact on the family being counseled as the actual work being done in therapy can have, because if the family or couple fails to build trust and believe in the therapist they are less inclined to comply and work through their issues.

One recent study about therapists and their ethical standards asked the therapists to name the top nine ethical decisions that therapists face in their day-to-day practice.

Ethics are beliefs about conduct and principles that inform rules for proper behavior (Corey, Corey, & Callanan, 1998; Knauss, 1997) (Vye, 2005). In mental health professions, ethics codes are intended to "set out expected professional behavior and responsibility" (Eberlein, 1987, p. 354) (Vye, 2005). However, studies involving ethical dilemmas have found a discrepancy among therapists between knowledge of proper actions and actual behavior (Bernard & Jara, 1986; Bernard, Murphy, & Little, 1987; Smith, McGuire, Abbott, & Blau, 1991; Wilkins, McGuire, Abbott, & Blau, 1990) (Vye, 2005)."

Past research has shown that therapists when guided by legal codes of conduct usually follow those policies. However, when the situation depended on their individual choices they were not as likely to make the correct choice (Vye, 2005).

It is important for marriage and family therapists to conduct themselves with the highest ethical standards as a means of building trust with not only their clients, but also to build good will with society and its regard for the profession as a whole.

One recent study found that the more experienced a therapist or marriage counselor is the higher their ethical standard and level of integrity seemed to be as well. For example the study found that experienced therapists were less inclined to break confidentiality or warn an potential victim of danger because they felt strongly that they had to maintain the trust and confidentiality of their client above all else (Vye, 2005).

Confidentiality

One component of having an ethical standard as a marriage and family therapist is having a high level of confidentiality with clients (Grabois, 1997). If a client believes that the therapist will not maintain a high level of confidentiality the client is going to hesitate to open up and be honest with the therapist.

Since its earliest beginnings, psychotherapy has been concerned with confidential communications. When a patient and a psychotherapist enter into a therapeutic relationship, the patient starts to reveal details about his thoughts and feelings that he or she may have told no other. The therapist becomes the "keeper of the secrets (Grabois, 1997)."

Clients in a therapeutic setting often reveal their deepest fears and concerns as well as their most embarrassing thoughts. They often reveal things that they have never shared with another person before. These confidences can include crimes committed against others, crimes that have been committed against the client, fears that have never been voiced or desires that are outside of the norm. There is almost no limit or boundary when it comes to the type of secret that a client may share with his or her therapist. The corner stone of the relationship between the therapist or counselor and the client is the level of confidentiality.

Although confidentiality has been a major component of the psychotherapeutic relationship since Freud, sometimes there is a breach of that confidentiality. Patients will seek to hold the therapist liable for the breach (Grabois, 1997)."

This serves as a reminder that confidentiality is not only important because of the trust that must exist between a client and a therapist from a therapeutic standpoint, but it can also create legal liability for the therapist if that confidentiality is not respected and upheld.

More than ever before, the public has become aware of breach of confidentiality of the therapeutic relationship (Grabois, 1997). In 1986, when Diane Wood Middlebrook was writing an authorized biography of the poet Anne Sexton, Anne Sexton's psychiatrist made 300 therapy tapes available to the biographer (Grabois, 1997). Although the late Sexton had detailed permission in her will for four of the tapes to be released, it was her daughter, the estate executor who provided permission for the other 296 tapes to be heard (Grabois, 1997).

This release of Sexton's therapy tapes caused great consternation in literary and psychiatric circles (Grabois, 1997). One psychiatrist called Dr. Orne's actions a "betrayal of his patient and his profession (Grabois, 1997)." Another noted the right of confidentiality survives the patient's death, and only the patient can give a release (Grabois, 1997). The family's wishes did not matter. Dr. Orne believed Anne Sexton would have jumped at the chance to share the tapes (Grabois, 1997). Charges were brought against Dr. Orne for violations of the Code of Ethics of the American Psychiatric Association, but a decision was made that no ethical violation occurred (Grabois, 1997).

The public outcry was deafening however, reminding therapists around the world of the importance of maintaining client confidentiality at all costs (Grabois, 1997).

The liability issues when it comes to the confidentiality between patients and clients cannot be understated.

Clients who come for therapy either as a family unit, a married couple or an individual do so because they have problems that they do not know how to handle. In some instances there is also a co-morbid condition or a mental illness involved (Grabois, 1997).

For a client to trust the therapist and share secrets, worries, and symptoms that are germane their life is an important part of the recovery process for their family or marriage. If the therapist breaches the confidentiality of the client might react with self-harm, or harm to others. In addition the reaction may cause the client to be so embarrassed or angry that he or she is unable to function in his or her daily profession which will then cause a loss of income and a possible loss of lifestyle or standard.

These are all potentially liability issues for the therapist who breached the confidentiality of his or her client.

It is important for the therapist to understand the importance of confidentiality with their clients because they are in a unique position when it comes to the chance of being sued for breaching that trust (Grabois, 1997).

Patients who discover their therapist has breached that trust are often reluctant to sue for several reasons.

The breach of trust can worsen an already existing emotional disorder and the client is not emotionally able to undergo the rigors of a suit and testifying.

In addition the client and therapist usually have a close relationship in which the client has revealed his or her deepest self to that therapist. The client is then hesitant to sue over a breach of trust because the client feels bonded to the therapist and does not want to hurt the therapist by suing.

Another issue with confidentiality breaching is that the client has revealed secrets to the therapist and may be concerned that a lawsuit will cause those secrets to become part of public record or be testified about on the stand (Grabois, 1997).

Two additional factors may explain the lack of claims by patients against their therapists (Grabois, 1997). These factors have a close connection to the intensity in this type of therapeutic relationship (Grabois, 1997). One factor is that patients do not recognize the psychotherapist's role in their distress, and the other is that psychotherapists are experts at handling people and their emotions (Grabois, 1997). If a patient is dissatisfied, the therapist can satisfy his or her doubts, or dissuade the patient from his or her anger (Grabois, 1997)."

Because of the things that would cause a client not to take legal action against a therapist who breached the confidentiality clause of the contract between the patient and the therapist, it is all the more vital that the therapist maintain a strict standard of integrity.

By doing this the therapist provides protection of the client and his or her personal issues and beliefs which can only serve to better address the client's needs and help the client work through the problems and move toward an emotionally healthy life.

Guttmacher and Weinhofen have noted that the psychiatric patient "confides more utterly than anyone else in the world (Grabois, 1997):"

He exposes to the therapist not only what his words directly express (Grabois, 1997); he lays bare his entire self, his dreams, his fantasies, his sins, and his shame. Most patients who undergo psychotherapy know that this is what will be expected of them, and that they cannot get help except on that condition (Grabois, 1997)."

It is vital that the client trust the therapist and this will only happen when the therapist conducts himself or herself with the utmost integrity and provides the highest standard of confidentiality (Cox, 2005).