national regulatory associations, and sometimes international regulatory entities. Again, each of these groups has a recursive influence on the others: We often find, for example, that there is very little difference between the legal requirements for the practice of couples and family counseling and the certification requirements of various professional organizations. Indeed, it is not uncommon for licensure requirements to include specific professional certifications as a first step toward licensure.
All of the professional regulation agencies attempt to address three questions related to family practice: What is family counseling or therapy? How is competence as a family practitioner assessed and measured? How valid and relevant are those competency measures for protecting consumers?
Stukie and Bergen (2001) suggested 10 principles that should be considered in the development of professional regulations in the field. Among their recommendations are a comprehensive model based on effective professional development and growth rather than minimal competence; fully funded, staffed, and empowered regulatory boards; integrated regulatory boards that address all aspects of psychotherapy rather than separate disciplines; ongoing competency assessments that are demonstrable in spite of the costs and logistical problems that may be involved; standards of practice that detail requirements related to advertising, record keeping, informed consent, and other legal expectations for practitioners; disciplinary procedures that are immediately responsive to the needs of clients and practitioners; and the right of consumers to choose the mental health providers of their choice.
The field of psychotherapy in general, and couples and family therapy in particular, is no longer dominated by psychiatrists and doctoral-level psychologists. By far, most couples and family practitioners were trained at the master’s level and completed approximately 2 years of supervised practice before being evaluated and obtaining a license. This dramatic change has taken place in just the past 30–40 years. The number of people seeking psychotherapeutic services is also on the rise. To protect consumers and define professional identities and competence, professional regulations and state laws will become increasingly specific in their definitions and requirements for practice. Although it is impossible to legislate virtue, morality, good judgment, or clinical skills, state laws and professional regulations forge a professional covenant with the public. These regulations are always based on the application of principle ethics—and the principles always reflect the dominant community standards of the state or organization enacting them.
Indeed, state and national laws often take certain moral, ethical, and professional issues out of the hands of the practitioner. Helping professionals in most states, for example, are mandated to break confidentiality and take affirmative, prescribed actions if (a) clients are dangerous to themselves, to others, and in some states, to property; (b) clients engage in or suffer child or elder abuse; or (c) the helping professional is otherwise required to do so by courts in the administration and application of specific laws. Such mandates are considered in law to be so serious that the covenant with consumers requires a consistent outcome every time (i.e., reporting)—even if the outcome can be demonstrated to create more problems than it solves.
State and federal legal requirements have also created standards of care for psychotherapeutic practice. This is especially true for those professions and professionals who must operate under HIPAA requirements and standards. Failure to meet professional standards of practice is the most common grounds for malpractice and incurred liability. It is what makes professional liability insurance a necessity these days and increasingly expensive to purchase.
Summary
Ethical practice is supported by an understanding of ethical principles, virtues, the law, professional codes of ethics, models of ethical decision-making, and you. If you are in the presence of your client, you are engaged in an ethical encounter— from the time you prepare for an upcoming session through the completion of your weekly case notes. During all aspects of the encounter, you have the potential to harm or promote the well-being of your client. An ethical practitioner recognizes the subtle, nuanced ways in which counseling or therapy influences clients. Ethical encounters highlight the importance of personal awareness and presence in therapeutic relationships.
Where to Go From Here
You can access the main ethics codes related to counseling, psychotherapy, and family practice through the websites of the following professional organizations:
American Counseling Association (www.counseling.org)
International Association of Marriage and Family Counselors (www.iamfconline.org)
American Association for Marriage and Family Therapy (www.aamft.org)
Recommended Readings
1 Coale, H. W. (1998). The vulnerable therapist: Practicing psychotherapy in an age of anxiety. Haworth Press.
2 Cohen, E. D., & Cohen, G. S. (1999). The virtuous therapist: Ethical practice of counseling and psychotherapy. Brooks/Cole-Wadsworth.
3 Golden, L. B. (2004). Case studies in marriage and family therapy (2nd ed.). Merrill/ Prentice Hall.
4 Wilcoxon, S. A., Remley, T. P., & Gladding, S. T. (2013). Ethical, legal, and professional issues in the practice of marriage and family therapy (5th ed.). Pearson.
Notes
1 1 Mark Young is a colleague from Gonzaga University. David Kleist is also a colleague of mine, but from Idaho State University. Because Mark and David actually teach courses in legal and ethical issues in couples and family counseling, and I (Jim Bitter) do not, I asked them to help me present the issues and processes that are essential to our work.
2 2 Among other things, HIPAA sets very strict standards for how patients’ medical records may be used. By extension, these requirements apply to any licensed person or group accepting third-party payments and/or filing reports with third parties.
3 3 For an example of such a session in action, see Bitter et al. (2004).
PART 2 Theories and Practice in Couples and Family Counseling
INTRODUCTION TO THE CASE OF THE QUEST FAMILY
CHAPTER 5 Object Relations Family Counseling
CHAPTER 6 Adlerian Family Counseling
CHAPTER 7 Multigenerational Family Counseling
CHAPTER 8 Human Validation Process Model
