Application of AAMFT Code of Ethics

Application of AAMFT Code of Ethics

How to manage the mother’s request to establish communication with the physician in light of therapeutic mandates for privacy and confidentiality

For optimal effectiveness of therapy, a person should be able to disclose their behaviors, experiences, feelings, and thoughts without fear of being judged. The patient should also be confident that the information they share with the therapist is not disclosed to third parties. The ability of a patient to be vulnerable is important to supporting a therapeutic alliance that is strong and which can help a person to recover much faster. When a child feels that he is unable to disclose what he wants in a safe environment, then the therapist will miss out on gathering important information on the kind of help to give the patient (Silber, 2020). For patients who are minors, the right to privacy when seeking therapeutic help is limited. However, although children do not have similar rights to confidentiality as those accorded to adults, and also rights to privacy from their parents, they still have a right to privacy from third parties such as advertisers and employers, among others.

According to the AAMFT Code of Ethics Standard 2.2 (2015), a marriage and family therapist is not allowed to disclose any confidences of the patient except through a waiver or written authorization or, in some cases, through permitted or mandated law. The code explicitly states that verbal authorization is not sufficient except in emergencies or unless the law prohibits the same. The client, in this case, is a minor, and the parents have the authority to make treatment decisions. The patient’s mother has informed the child’s physician that he is in therapy for his disruptive behavior. It is not certain whether it is the mother who wants the physician involved or whether it is the physician who requested to be involved. It is highly doubtful that the physician would like to be involved as he ought to be aware of the codes of ethics on patient confidentiality.

Nonetheless, as the patient’s therapist, I will not disclose the details of the therapy as it is against the code of ethics. I will inform the physician of the same and refuse to release information. If the mother of the patient persists in having the physician told, I will request the mother to have the request put in writing to avoid any future lawsuits against the practice (Leslie, 2005).

Actions in light of your obligations as a mandated reporter

A child’s physical abuse is defined as the acts of commission done to a minor by a caregiver that causes or has the potential to cause harm. Sexual abuse, on the other hand, refers to where a caregiver gets sexual gratification from molesting a child. Emotional abuse is where a caregiver fails to provide a supportive or appropriate environment, and this also includes acts that have adverse effects on the child’s development and emotional health. Examples of such actions include rejection, discrimination, intimidation, threats, ridicule, denigration, and restriction on child movements, among others (Zeanah & Humphreys, 2018). Child neglect refers to the failure of a parent to provide for a child’s development when the parent is able to do so. A parent who neglects a child fails to provide nutrition, emotional development, education, health, safe living conditions, shelter, and food. Neglect is, therefore, differentiated from poverty in that it occurs when resources are available but are denied to the child by the caregiver (Zeanah & Humphreys, 2018).

For persons working with children, one must recognize abuse and neglect. If a practitioner has reason to believe or is certain that a child is being physically abused, the practitioner must seek to confirm these suspicions. Once confirmation is made, the practitioner must report to a police station and child protection services. A mandated reporter is legally obligated to report any form of child abuse or neglect to the relevant authorities. The laws that protect children are in place to end at the earliest possible time, any form of abuse and neglect. A mandated reporter ought to notify the proper authorities of the neglect and abuse of a child. In this case, as the child’s therapist, I am mandated to report to child protection services the possible abuse and neglect of the patient. The boy stated that his father locks him up all night in a bathroom, which is tantamount to abuse. The patient also said that the father does not give him anything to eat the next morning, which is equivalent to neglect. The frequency of these actions is not stated, but they should be stopped. Hence, reporting to child protection services and the police is necessary for the safety of the patient.

Possible actions keeping in mind Standard 1.3 from the AAMFT Code of Ethics

According to the AAMFT Standard code1.3 (2015), marriage and family therapists should be aware of the positions of influence they hold in reference to their clients and, hence, should avoid exploitation of dependency and trust of the patients. Therefore, a therapist should make every effort to avoid multiple relationships and conditions with clients that could pose a risk of exploitation or impair their professional judgment. Examples of such relationships include close personal or business relationships with a patient or the immediate family of the patient. A therapist should document the precautions they take when the risk of exploitation or impairment exists. In this case, the client’s father is the lawyer to the therapist’s parents. I do not believe that this is a close enough relationship between the therapist and the father to warrant the cessation of the patient’s therapy sessions. Therapy with the patient and the family will continue, but some preventive measures will need to be taken.

The first precautionary step will be to develop a treatment plan that is based on the culture, environment, venue, situation, personality needs, and problems of the client. Intervention with the client will be done according to their personalized treatment plans and their needs as well and not on my theoretical orientation. The next step will be to conduct a risk-benefit analysis, keeping in mind that inaction, such as rigid avoidance of entering any multiple relationships, may be significantly harmful. The third step is to consider the client’s welfare, treatment effectiveness, release of exploitation and harm, clinical impairment, and a conflict of interest. Fourthly, I will consult with non-dogmatic, open-minded, well-informed legal, ethical, and clinical experts in this case and document this consultation. Next, I will give the father to the patient a written policy to sign, which states the benefits and risks of multiple relationships, after explaining to him that the relationship that he has with my parents will not and should not affect the counseling sessions that he and his family attend at the clinic.

At the core of this treatment is the 10-year-old patient. He has already opened up about the abuse and neglect he is facing at home, which implies that the client is feeling safe confiding in me. It will take time for the client to create a similar relationship with another therapist; hence, for the sake of continuing with treatment, I will have the father sign the policy, as mentioned in the previous paragraph. Additionally, because the father is abusive and I will report to the child protection services, his role in the child’s treatment will be limited; hopefully, he will not retaliate against my actions against my parents.

My actions, keeping in mind Principle 1.11 from the AAMFT Code of Ethics

The relationship that therapists and patients have is different from other types of relationships in several ways. One of the ways that this relationship is different is that it is time-bound; the association will need to be terminated at one time when therapy ends. It helps to have some basic planning in place prior to the sessions coming to an end to assist in managing the ending. According to Kealy et al. (2020), termination is a term that refers to the process where a patient ends the therapy services with the counselor. At times, the termination can be for a while and open for continuation, while in some cases, it is final. The patient can return later for more counseling sessions. Referral is a term used when a counselor terminates a counseling relationship with a patient but recommends another therapist to take over the sessions. Referral often occurs when the presenting case is beyond the expertise of the current therapist. Abandonment, on the other hand, is where a counselor leaves a patient without any further assistance or provision of services (Wilcoxson et al., 2013).

According to the AAMFT Code of Ethics 1.11, a marriage and family therapist should not neglect or abandon the patient without having prior arrangements on how the patient can continue with treatment. A therapist should take the necessary steps to avoid leaving their patients, which will be appropriate to the needs of the patient. Thus, to avoid leaving the patient, I will give recommendations to the parents on how to continue with the patient’s treatment.

Some of the recommendations I will give to the patient include negotiating the fees that the parents are currently paying for the patient. I will discuss with the parents possible discounts per therapy session and agree on a price that is affordable for them (Grey, 2020). If this option is not workable, I will recommend the parents get assistance from the Open Path Psychotherapy Collective; I will contact the initiative on their behalf. The collective offers affordable mental health services for lower-income and middle-income individuals and persons. The costs per session vary between $30-50 per hour, which could be reasonable for the patient (Grey, 2020). The third option would be to contact the local community-based center on behalf of the patient, as this will offer a low-cost or free mental health service (Grey,2020). The last option will be to contact the local university hospital as this offers programs where residents and interns are paid on a sliding scale, which is lower in cost compared to private practice (Grey 2020).

My actions on a subpoena from the mother’s lawyer asked me to be part of the court proceeding.

When a divorce or child custody case is on trial, there are likely to be a number of witnesses who come to give their testimonies in court. One such witness is a marriage and family therapist who can testify in favor of or against one of the parties. Most courts deem therapists as experts in their field and their testimony as relevant to the case issues (Ormerod & QC, 2013). For example, where a child has psychological problems that need continued treatment, the opinion of the therapist will be instrumental in deciding which parent should have more time with the child. The therapist will also give an idea of the preferred parent for child custody and whether the courts should limit one of the parent’s limitations on visits. When a therapist is called to give their testimony, they should stick to the facts and discuss only the medical findings, the condition of the patient, and the treatment course they undertook. The therapist should refrain from giving their views on issues with reference to the case. As an expert witness, the therapist will provide their opinion on who should have child custody and visitation rights (Ormerod & QC, 2013). In this case, the mother is petitioning for sole custody and would like for me to give my testimony based on the revelation that the child made concerning the abuse and neglect meted out to him by his father. The mother is hoping that my testimony will allow the court to rule in her favor to have full custody of the child.

According to the AAMFP code of ethics 7.2 (2015), a marriage and family therapist can provide fact or expert witness testimony but should avoid any misleading judgments. The therapist should base all the conclusions pertaining to the legal proceedings on the appropriate data and prevent any form of inaccuracies. As a therapist, I will strive to offer my testimony to the divorce proceedings in an independent, fair, objective, and accurate way. The mother of the patient will need to clarify to me whether I am testifying as both an expert and fact witness so that I can prepare my testimony accordingly. I will also need to meet with the mother of the patient as well as her attorney and find out what information they require for me to testify in court. Lastly, I will need confirmation from the attorney on whether the files and records I have on the patient are subpoenaed as well so that I can avail the same to the attorney.

Soap Note: 10-Year-Old patient

SUBJECTIVE

The mother of the patient stated that: “My son has become very disruptive in school.”

OBJECTIVE

The patient is a 10-year-old boy who his mother brought in with the support of his father. The patient was diagnosed with a sleeping disorder a few months ago. He is irritable and will look for reasons to fight other pupils in school. The patient has a normal intake of fluids and foods. He appeared moody.

ASSESSMENT

The patient presents as a sad and moody patient. The general demeanor and facial expressions revealed sadness and depression. The effect was appropriate, with no apparent signs of indicators of psychosis, bizarre behaviors, delusions, or hallucinations. He was initially not open to talking to the therapist, but after the third session, he was willing to open up. The patient stated that whenever he went to sleep, he would stay awake until around 3 a.m. He also said that he had difficulty waking up. During the third session, the patient said that his father would get very angry whenever the patient did not sleep at the required time. The patient said that the father would close him in the bathroom all night, and in the morning, he would get nothing to eat. The patient also was reported to start fights in school, and despite threats of detention and suspension from the school, he continued to fight. The patient was attentive during the sessions and was cooperative. The patient did not show any signs of anxiety, neither did he have any gross abnormalities in behavior. His fund of knowledge and cognitive functioning were age-appropriate and intact. The short and long-term memory was also unchanged. The patient was also able to do arithmetic and abstract calculations. He was fully oriented but did not have any insight into his problems. His judgment appeared to be fair. Additionally, the patient exhibited speech that was normal in articulation, volume, spontaneity, coherence, and rate.

PLAN

Diagnosis: The following are the possible diagnosis based on the information and could change if any additional information is availed:

Generalized anxiety disorder- F41.1 (ICD-10) (Active)

Anxiety disorder unspecified- F411.9 (ICD-10) (Active)

Major depressive disorder, moderate but recurrent -F33.1 (ICD-10) (Active)

Treatment plan linked to the problem: Depressed mood

Final Diagnosis: Depressed mood

The patient is depressed, as identified by the active problem that is yet to be treated.

Long Term Goal: the patient will develop the skills of identifying his feelings of depression and activate the coping skills he will learn from the therapy sessions.

Short term: The patient will identify anger triggers and practice breathing exercises to avoid engaging in school fights.

Risk Factors

Abusive father

Non-compliance to medication

Time spent with the patient on face-to-face psychotherapy: 60 minutes per session for ten sessions

 

Signed:

Date:

References

AAMFT. (2015). AAMFT Code of Ethics. Retrieved from: https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

Grey, G.R. (2020). How to Access Therapy and Other Mental Health Services If You Don’t Have Insurance. https://www.goodrx.com/blog/therapy-mental-health-services-without-insurance/

Kealy, D., Gazzillo, F., Silberschatz, G., & Curtis, J. T. (2020). Plan-compatible termination in psychotherapy: Perspectives from control-mastery theory. Psychotherapy.

Leslie, R. S. (2005). The written authorization: A closer look. Marriage and Family Therapy Magazine, 4(1), 45-47.

Ormerod, D., & QC, J. S. (2013). Working with the courts: Advice for expert witnesses. In Forensic Psychologists Casebook (pp. 198-222). Willan.

Silber, T. J. (2020). Mature minors, consent, and confidentiality.

Zeanah, C. H., & Humphreys, K. L. (2018). Child abuse and neglect. Journal of the American Academy of Child & Adolescent Psychiatry, 57(9), 637-644.

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When providing your reflections pertaining to the ethical decision, please provide references to the specific Standards of the AAMFT Code of Ethics. Please be mindful to outline your reasoning for each decision that you are making pertaining to the chosen course of action. In addition, you can modify the information in the vignette by adding any necessary details that will help you to illustrate your ethical and legal decisions.

This assignment will be used to verify you have met the Ethics requirement for clinical readiness (seeing clients in the clinical training portion of the program) as a part of the Practicum Preparation Process (PPP). Please be sure to apply all that you have learned throughout the course to the analysis of the vignette and your responses to the questions. In order to meet the Ethics requirement of the PPP, you must receive a score of 83% (B) or higher on this assignment. Failure to achieve this score will result in the need to complete a separate ethics essay during the PPP. If you have questions about this assignment, you are encouraged to consult with your faculty member before you submit it.

Case Vignette:
Your client is a 10-year-old boy who was referred by his mother following his disruptive behavior at school and home. The mother was the referring person, while the father also supported the mother’s decision to initiate therapy. You are able to establish a good rapport with the boy and work through some of his issues.

Write your responses to the following questions:
1. The mother informs you that a family physician who recently diagnosed her son with a Sleeping Disorder would like to know more about the boy’s therapeutic work and his success in therapy. The mother informs you that the physician will be contacting you shortly. Describe how you will manage the mother’s request to establish communication with the physician in light of therapeutic mandates for privacy and confidentiality.
2. One day, your client comes to the session and tells you that if he refuses to go to bed at a certain time, his father closes him in a bathroom for the rest of the night and does not give him anything to eat the next morning. Please describe your actions in light of your obligations as a mandated reporter.
3. One day, you conducted a family session: the boy, the mother, and the father were all present. After the session, you realize that the boy’s father was your parent’s lawyer. Please discuss your possible actions, keeping in mind Standard 1.3 from the AAMFT Code of Ethics.
4. Ten sessions into the therapy, your client’s mother informs you that their insurance panel did not approve further treatment. Discuss your actions, keeping in mind Principle 1.11 from the AAMFT Code of Ethics.
5. One year after the termination of the therapy, you receive a subpoena from the mother’s lawyer asking you to be part of the court proceeding following the divorce of your client’s parents. The mother is asking the court to end joint custody in favor of sole custody. The subpoena asks you to provide information concerning the divorce and child custody as addressed in the previous therapy and that you will be called to testify. Please describe your actions.

Please provide an outline of your notes from your first session using SOAP or an alternative format. Describe essential components of the progress notes and address how long you will be required to keep records on file.