The family therapy process was described in detail beginning with before the initial interview and ending with termination. Family therapists must understand the family dynamic using the Systems Theory. The Systems Theory was defined and described in detail. Family therapists have different approaches to helping families depending on their unique issues. Each approach was defined and a reason for using these approaches were given.
The American Association of Marriage and Family Therapy Code of Ethics has eight sections. Each section was examined and explained in detail with examples of possible issues the family therapist may have. It is concluded that family therapists have a duty to adhere to and follow every section of the ethics codes to not only protect themselves, but their clients as well. It has also been determined that a family therapist must examine themselves and have a good understanding of their own values and beliefs. A family therapist must always put the needs of the clients ahead of their own.
Introduction to Family Therapy
Family therapy is a type of therapy that focuses on the unique family system. The goal of family therapy is to strengthen the family system as a whole, with each member adding its own unique contribution. The role of the family therapist is complicated by not only strengthening the family as a whole, but also dealing with each individuals issues. This paper discusses the process of therapy from before the initial interview to termination. Also, this paper discusses, in detail, the ethical code and the role ethics play in family therapy (Patterson, 2009). Systems Theory
Family therapists must understand how the family system communicates and what the nature of their relationship is. The System Theory is “an approach that defines family at its most elemental level…and breaks the family down to its most basic components, without which the family system would not exist (Jurich & Johnson, 2008). Winter (2001) states that the components of a system are:
1. Family systems have individual components that work together to create a single foundation 2. Each family system has its own predictable patterns of communication 3. Family systems have both internal and external boundaries 4. Each family system is a group of individuals that make up one whole group 5. Each family system has its own repetitive and redundant rules and messages 6. Family systems have their own subsystems that have their own set of rules and messages.
Before the first interview even takes place, the family must make the decision as to who attends therapy, what issues will be addressed, and who is responsible for the issues. Families entering therapy are taking a risk by coming to therapy as they have both a significant amount to gain and lose. From a family therapist’s point of view, the time before the first interview is extremely important.
The family therapist can receive considerable insight during the first phone call by listening to the client, assessing the nature of the problem, and determining the real reason for therapy. The family therapist also needs to determine whether they feel they are competent and experienced enough to help the client with their issues. The therapist should also avoid giving advice at this time and use this time to only gather information (Goldenburg & Goldenburg, 2011). Initial Interview
The initial interview is an extremely critical point in the therapy process. In this stage, the family therapist must establish a good rapport with the client as well as define boundaries and expectations. According to Margolis and Zweben (2011), it is helpful for family therapists to break the first interview into four stages. In the first stage, the therapists makes the clients feel welcome and eases their anxieties.
The second stage is where the family therapist covers all administrative issues such as confidentiality and informed consent policies. In the third stage, the therapist asks the clients what they hope to achieve during therapy or establish goals for the therapeutic process. In the fourth and final stage, the therapist begins the assessment phase. Each stage can vary in length, with an average of 10-15 minutes for the first two stages and the last two can vary from a few minutes to a few sessions depending on the clients (Margolis and Zweben, 2011).
One of the best ways for a family therapist to complete the assessment stage is to follow a General Assessment Plan. A complete and accurate assessment will help the therapist get to know the clients as well as assist in developing a treatment plan. The first step in the general assessment plan is the initial assessment. An initial assessment will tell the therapist what the issue is that brought them to therapy, the individual in the family system that is most affected by this problem, and when and where the problem manifests.
During the initial assessment, the therapist will also determine what, if any, solutions the clients have attempted or considered attempting. This helps the therapist recommend other alternatives to solving the problem and increases their credibility. Another reason a therapist will assess clients is to determine to what extent the clients are in trouble. For example, the problem the clients are having may be a result of a collaboration of events rather than one single problem. The therapist must also determine what coping mechanisms the clients possess in order to build upon them in the treatment stage (Metcalf, 2011).
The second stage of the General Assessment Plan is for the therapist to assess whether the client is at risk of harming themselves or others. If the therapist finds that any of these are occurring, they are mandated to report either of these issues to the proper authorities as required by their state statute and code of ethics (Patterson, et. al, 2009). Assessing for substance abuse issues is stage three of the General Assessment Plan. Substance abuse can sometimes be overlooked if client fails to mention it. Therapists must also determine whether the client is a social drinker or has developed an addiction to the substance (Patterson, et. al, 2009).
The next stage of the General Assessment Plan is assessing the neurological and biological factors the client may present. Because therapists are trained to look for social and psychological factors, they may overlook any neurological and biological factors that may exist. In order to discover these factors, a therapist must have an open mind and be willing to explore topics. Patterson, et.al (2009) suggests therapists look for the following cues for biological symptoms: 1. No history of symptoms
2. No identifiable cause of symptoms
3. If client is 55 or older
4. Persistent physical illness
5. Substance Abuse
If any of these symptoms are found, a referral is necessary. For neurological problems, a therapist may need to evaluate the client further if they have problems with memory, learning, language, and organizing.
The final stage of the General Assessment Plan is the general psychological assessment which assesses the ABC’s: affect, behavior, and cognition. Lists of symptoms for the DSM-IV-TR disorders typically follow all three of the ABC’s. Though a therapist may not know all the symptoms in of each disorder in the DSM-IV-TR, they should know the most common: depression, anxiety, and substance abuse. It is also possible that the client’s symptoms may coincide with more than one DSM-IV-TR diagnosis (Meyer, et. al, 2001). Development a Treatment Plan
After the assessment stage of the therapeutic process, a family therapist must develop a treatment plan. A thorough treatment plan has seven steps: develop a problem list, determining the client’s goals, treat the client using the therapists theory and DSM-IV-TR diagnosis, develop long-term treatment plan, decide how many times and for how long a client will need treatment, and determine whether a referral needs to be made or if any outside resources will be helpful .
First, a therapist must help the clients identify and list all problems in which the family would like to address. Second, the therapist will help the family prioritize the list in order to keep both the clients and therapist focused and task-oriented. Third, the therapist must have a clear idea on what the clients’ goals are and what they plan to get out of the therapy sessions. In the fourth step, the therapist will begin treating the clients based in the therapists approach.
Nichols and Everett (1986) suggests new therapists use “and integrative approach to conceptualization and treatment…a solid foundation in systematic thinking and the consideration of multiple systems” (Nichols & Everett, 1986). A family therapist will use a different approach depending on the issues the family is having. These approaches are communications approach, structural approach, family systems approach, strategic family therapy approach, social learning approach, and narrative approach (Sheafor, Horejsi, & Horejsi, 1997).
The communications approach is used when the family has problems with communication. The therapist will help the family learn to communicate by modeling and many different exercises that will help them develop better communication skills. The structural approach is used when the family structure is out of balance. The family therapist will help align the family structure by establishing the roles and responsibilities of each family member.
The family systems approach is used when the family is not working as a team, but as an individual entity. A family connection and boundaries must be set with the help of the therapist for this approach to be successful. The strategic family approach will help families develop rules and spread out the power within the family dynamic. The family therapist will also help a family work on a pattern of behavior that is appropriate for each family.
A therapist will use tools from behavior therapy and behavior modification therapy with the social learning approach. This approach helps members of a family cope with issues and teach them basic skills in communicating, interacting, and behaving as a family unit. A family therapist will use the narrative approach when helping the family identify and describe their problems by comparing them to stories, fables, movies, etc. (Shearor, Horejsi, & Horejsi, 1997). Termination
Termination, though sometimes hard for a therapist to do, can be very liberating for both the client and the therapist. There are three types of termination: when a client terminates, when a therapist terminates, and when both client and therapist agree to the termination. The ideal situation for both the client and therapist is mutual termination. A client may decide to terminate therapy for a number of reasons.
They may not like or agree with the therapist, they may simply not show up for therapy, or they may not feel they need therapy anymore. A therapist may decide to terminate therapy if an agreement on treatment cannot be reached, if the therapist is unable to help the client for any reason, or boundaries have been crossed. A mutual termination usually occurs when the client has reached the end of the therapy process and reached all their goals (Patterson, 2009). Ethical Issues in Family Therapy
There are various ethical issues that can arise with family therapy. Ethical questions regarding family therapy can become unique and complicated when dealing with more than one individual person. What may serve in the best interest of one person, may conflict with the interests of another. To help guide family therapists with these ethical dilemmas, The American Association for Marriage and Family Therapy (AAMFT) has developed a code of ethical standards.
The AAMFT code of ethics is divided into eight principle sections: responsibility to clients, confidentiality, professional competence and integrity, responsibility to students and supervisees, responsibility to research participants, responsibility to the profession, financial arrangements, and advertising (Cory, Corey, & Callanan, 2011). Principle I: Responsibility to Clients
This principle states that the therapist must work to improve the overall welfare of both the family and individual as well as respect their right. Section 1.1 of the AAMFT Code of Ethics (2012) states that “Marriage and family therapists must provide professional assistance to persons without discrimination on the basis of race, age, ethnicity, socioeconomic status, disability, gender, health status, religion, national origin, sexual orientation, gender identity, or relationship status”.
Marriage and family therapists must acquire an informed consent document from clients. This document is a written agreement between the therapist and clients regarding treatment plans and processes, risks and benefits of treatment, defines boundaries, and any other information needed for the clients to make informed decisions about therapy (Corey, Corey, and Callanan, 2011). Marriage and family therapists must also make every effort to avoid entering in any type of multiple or sexual relationship with a client or a client’s immediate family members.
The AAMFT states that a therapist may only enter a sexual relationship with a client 2 years after termination of therapy (AAMFT, 2012). Section I of the AAMFT’s code of ethics also requires marriage and family therapists to report any unethical behavior and that they do not use their professional relationship to their advantage. The focus should always be on the client and the clients’ therapy goals, not the goals of the therapist. Therapy decisions should also be made by the client and not influenced by the therapists own agenda or opinions (AAMFT, 2012).
Marriage and family therapists must not participate in any relationship that may be harmful to the client. If in the event that the therapist is unable to provide the best professional help to the client, the therapist must refer the client to another therapists. A therapist may refer the client if they are not knowledgeable in an area the client needs help in. A therapist must also not abandon the client; the therapist must refer the client to another therapist or for services for the continuation of treatment.
According the AAMFT, codes 1.12 and 1.13 in require a marriage and family therapist to gain written consent from the client before audio, video, or allowing others to observe a therapy session (Robert & Hepworth, 1990). Principle II: Confidentiality
Marriage and family counselors have a different set of ethical concerns simply because they work with more than one client at a time. Principle II states that therapists must uphold the confidentiality of all individual clients. Marriage and family therapists can only break the confidentiality agreement they are mandated by law regarding abuse or neglect or if the client is in danger from either themselves or someone else.
The therapist can also break confidentiality if the therapist is a defendant in a court action stemming from therapy or if the client signed a waiver agreeing to the breaking of confidentiality (AAFMT, 2012). Principle III: Professional Competence and Integrity
Principle III of the AAFMT code of ethics requires all marriage and family therapists “to maintain high standards of professional competence and integrity” (AAFMT, 2012). This code requires marriage and family counselor’s to continue their education to keep up to date on the latest therapy techniques and supervision.
This section of the AAFMT code of ethics also requires marriage and family therapists to ask for help from other professionals and to refer a client if there is a conflict of interest. Marriage and family therapists are also not to engage in any form of harassment or exploitation of a client. Marriage and family therapists are also not to accept any gifts from a client of high monetary value or if it would hinder the relationship between the client and therapist (AAFMT, 2012).
Also discussed in Principle III is separation of custody evaluation from therapy and professional misconduct. The AAFMT code of ethics states that a marriage and family therapist must not participate in any evaluation for custody, residence, or visitation of a minor child being treated by the therapist. This is to ensure confidentiality is not broken and to avoid any conflict of interest.
A marriage and family therapist will be in violation of the AAFMT’s Code of Ethics if he or she has had any misdemeanor or felony convictions, have disciplinary actions brought against them, have their license taken away or suspended, are not physically or mentally sound to continue to practice, and fail to adhere to these codes of ethics. If the therapist violates these codes, they may lose their membership to the AAFMT and may face litigation (Corey, Corey, & Callanan). Principle IV: Responsibility to Students and Supervisees
Principle IV of the AAFMT code of ethics states that marriage and family therapists must not take advantage of the client while they are trusting and vulnerable to the therapist. The therapist must also not engage in multiple or sexual relationships with their students or supervisors. A marriage and family therapist must always remain objective and engaging in multiple or having a sexual relationship with either a student or supervisor may take the focus away from the clients’ therapy (AAMFT, 2012). Principle V: Responsibility to Research Participants
In Principle V of the code states that “investigators respect the dignity and protect the welfare of research participants, and are aware of federal and state laws and regulations and professional standards governing the conduct of research (AAMFT, 2012). Researchers are also required to follow all laws, regulations, and procedures of the organization they are working with. Investigators must also use informed consent and maintain confidentiality unless a waiver has been signed by the client (AAMFT, 2012). Principle VI: Responsibility to the Profession
This section of the AAMFT’s code of ethics discusses the marriage and family therapists respect for the profession and the profession’s colleagues. Marriage and family therapists are required to follow the AAMFT code of ethics even when there is a conflict with the therapist’s organization’s code of ethics.
Also, a therapist must not see a client that is seeking help from another therapist without informing that therapist. The marriage and family therapist will uphold all mandating laws and report any colleague that may be practicing without the proper credentials and will work pro bono for the community (Corey, Corey, and Callanan, 2011). Principle VII: Financial Arrangements
It is considered unethical for a therapist to not discuss financial arrangements with a client, third party payers, or therapists they are supervising for. Marriage and family therapists must make these arrangements reasonable and understandable to the client. Therapists must not accept bartering in exchange for payment as this has the potential to affect the therapist and client relationship as well as take the focus off the goal of therapy (Corey, Corey, & Callanan, 2011).
Principle VIII: Advertising
Marriage and family therapists are required in this code to represent themselves accurately. They must be truthful about their education, knowledge, skills, and experience regarding marriage and family therapy. They must correct any misleading or false information immediately and are not allowed to advertise a specialization that is also misleading (Corey, Corey, and Callanan, 2011). Conclusion
In conclusion, a family therapist’s role to help a family strengthen their
values and work on the individual issues each has in order to make the family system work together. The American Association of Marriage and Family Therapy has developed a code of ethics to specifically help family therapists deal with the difficult issues that may arise with family therapy.
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