This paper examines the ethical issues that arise in the practice of family and marital therapy, with particular attention to how standard psychological ethical codes apply — and sometimes fall short — when multiple clients are treated together. The paper traces the history and purpose of ethical standards in psychology, then addresses specific challenges such as informed consent, confidentiality, and competing client interests within couples and families. It further considers special populations including LGBT couples, children, men, and women, as well as social factors such as religion and multicultural diversity. The paper concludes with recommendations for improving ethics training in graduate marriage and family therapy programs.
Ethical issues in family and marital therapy are critical to understand when helping those in need. Families and marriages face a wide range of challenges every day, and ethical considerations are vital when addressing these matters. For example, the significant increase in average life expectancy since the turn of the century has created conditions in which families must balance the needs of multiple generations simultaneously. Families also face the burdens that affect many marriages and intimate relationships. With these challenges in mind, this paper explores the key ethical issues that arise in family and marital therapy, drawing on professional standards, theoretical frameworks, and clinical considerations.
Unethical behavior on the part of therapists has represented an area of growing concern among mental health professionals, as reflected in the increasing number of complaints filed with ethics boards (AAMFT, 1994; APA, 1988). Preister, Vesper, and Humphrey (1994) documented that the Ethics Committee for the American Association for Marriage and Family Therapy (AAMFT) maintained an active caseload of over 100 claims per review period in recent years — representing a roughly sevenfold increase in ethics cases dating back to 1986.
The Preamble and General Principles of the APA Ethics Code are considered aspirational goals that guide psychologists toward the highest ideals of the profession. Although the Preamble and General Principles are not themselves enforceable rules, psychologists are expected to consider them when determining an appropriate ethical course of action. The Ethical Standards, by contrast, are enforceable rules of conduct for psychologists. Most of the Ethical Standards are written broadly so that they can apply to psychologists across diverse roles and settings, though the application of any given standard may vary depending on context. The Ethical Standards are not exhaustive; the fact that a particular behavior is not explicitly addressed by an Ethical Standard does not mean it is necessarily either ethical or unethical.
The current guidelines for clinical practice are rooted in a combination of ethical theory and history — much of it shaped by tragic events. The word "ethics" originates from the Greek ethos, meaning character or custom. Ethics is often compared with morals, which typically refer to values learned at home through upbringing, parents, religion, culture, and other influences (Callan, 2005). Ethics is considered more systematic: it is the methodical study of standards by which one determines what is right and wrong.
Over the 4,000-year history of ethical thought, numerous theories have emerged regarding what ethics should be and which values should take priority. In examining and applying these ethical theories, scholars and practitioners attempt to justify specific rules, actions, or positions on what we ought to do. The challenge — particularly in a practical setting such as clinical research — is to translate theoretical ideas from ethics into action. Professional codes and standards help practitioners accomplish this task.
The APA Ethics Code applies to psychologists' activities that are part of their scientific, educational, or professional roles. Areas normally covered include, but are not limited to, clinical, counseling, and school psychology practice; research; public service; policy development; social intervention; teaching; supervision of trainees; development of assessment instruments; conducting evaluations; educational counseling; organizational consulting; forensic activities; program design and evaluation; and administration (Bass, 2006). The Ethics Code applies across a diversity of settings — including in-person, mail, telephone, internet, and other electronic communications (McLaurin, 2004). Membership in the APA obligates members and student affiliates to comply with the APA Ethics Code and the procedures used to enforce it (Peluso, 2003). Lack of awareness or misunderstanding of an Ethical Standard is not itself a defense against a charge of unethical conduct.
Psychologists have a primary duty to take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the scope and limits of confidentiality may be governed by law or established by institutional policies or professional or scientific organizations. Psychologists discuss with individuals — including, to the extent feasible, those who are legally unable to give informed consent and their legal representatives — and with organizations with whom they establish a professional relationship: (1) the relevant limits of confidentiality, and (2) the foreseeable uses of the information generated through their psychological activities.
When obtaining informed consent for therapy, psychologists inform patients or clients as early as possible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality, and provide adequate opportunity for the client or patient to ask questions and receive answers (McLaurin, 2004).
When psychologists agree to provide services to multiple persons who have a relationship with one another — such as spouses, partners, or parents and children — they take reasonable steps to clarify at the outset (1) which individuals are patients or clients, and (2) the relationship the psychologist will have with each person (Scher, 2012). This clarification includes the psychologist's role and the likely uses of the services provided or the information obtained. If it becomes apparent that psychologists may be called upon to perform potentially conflicting roles — for example, serving as a family therapist and then as a witness for one party in divorce proceedings — they take reasonable steps to clarify and modify, or withdraw from, those roles appropriately (Callan, 2005).
"Competing client interests and multi-client ethical conflicts"
"Systems theory and emotion-focused therapy frameworks"
"Religion, multiculturalism, gender, and LGBT considerations"
"Future research and improved ethics training proposals"
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